Provider Demographics
NPI:1093500035
Name:GARDNER, FELICIA B (LPC-IT, CRC)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:B
Last Name:GARDNER
Suffix:
Gender:
Credentials:LPC-IT, CRC
Other - Prefix:
Other - First Name:FELICIA
Other - Middle Name:B
Other - Last Name:WILLMINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:641 7TH ST N
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-3571
Mailing Address - Country:US
Mailing Address - Phone:715-630-9260
Mailing Address - Fax:
Practice Address - Street 1:641 7TH ST N
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-3571
Practice Address - Country:US
Practice Address - Phone:715-630-9260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8341-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional