Individual
MS. HEATHER LYN GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LLP, LLPC
Contact information
Practice address
534 FOUNTAIN ST NE, GRAND RAPIDS, MI 49503-3422
(616) 456-1178
(616) 456-1324
Mailing address
534 FOUNTAIN ST NE, GRAND RAPIDS, MI 49503-3422
(616) 456-1178
(616) 456-1324
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6401009748
MI
103T00000X
Psychologist
6301013130
MI
Other
Enumeration date
04/14/2007
Last updated
10/05/2009
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