Provider Demographics
NPI:1427655059
Name:GARDNER, ABBIE JANE (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ABBIE
Middle Name:JANE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 WYNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-2053
Mailing Address - Country:US
Mailing Address - Phone:440-666-8050
Mailing Address - Fax:
Practice Address - Street 1:6765 STATE RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-4581
Practice Address - Country:US
Practice Address - Phone:440-666-8050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.10341235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist