Provider Demographics
NPI:1427469527
Name:GARDNER, REBECCA (SLP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3607 SHANNON RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1928
Mailing Address - Country:US
Mailing Address - Phone:216-926-9036
Mailing Address - Fax:
Practice Address - Street 1:3607 SHANNON RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44118-1928
Practice Address - Country:US
Practice Address - Phone:216-926-9036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP10180235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist