Individual
GARDNER CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2225 CHALLENGER WAY, SANTA ROSA, CA 95407-5441
(707) 565-4970
(707) 565-5183
Mailing address
2225 CHALLENGER WAY, SANTA ROSA, CA 95407-5441
(707) 565-4970
(707) 565-5183
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
31251
CA
Other
Enumeration date
02/10/2019
Last updated
02/10/2019
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