Individual
MRS. DIANE GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
398 BLUE JAY DR, LIBERTY, MO 64068-1977
(816) 407-2315
(816) 407-1555
Mailing address
2609 GLENN HENDREN DR, LIBERTY, MO 64068-1738
(816) 407-4555
(816) 781-6973
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
01461
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
466887825
—
MO
Enumeration date
03/29/2007
Last updated
02/27/2018
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