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Individual
MICAH R GARDNER
Active
Individual
MICAH R GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDCA
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
CDCA.173007
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0337903
—
OH
Enumeration date
03/08/2019
Last updated
07/24/2020
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