Individual
MS. EUNICE GRACE GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
777 HOSPITAL WAY, POCATELLO, ID 83201-5175
(208) 239-1710
Mailing address
777 HOSPITAL WAY, POCATELLO, ID 83201-5175
(208) 239-1710
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
103TA0700X
Adult Development & Aging Psychologist
Primary
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
Other
Enumeration date
07/05/2010
Last updated
10/24/2011
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