Individual
BRUCE GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
467 LINDA LN, LYNWOOD, IL 60411-4653
(773) 952-0492
Mailing address
14014 PARK AVE, DOLTON, IL 60419-1029
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
06/29/2023
Last updated
06/29/2023
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