Provider Demographics
NPI:1528500261
Name:GARDNER, KATHERINE BRADLEY (LMFT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:BRADLEY
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ANN ROGERS
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:5313 ARCTIC BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-1111
Mailing Address - Country:US
Mailing Address - Phone:805-242-3045
Mailing Address - Fax:
Practice Address - Street 1:5313 ARCTIC BLVD STE 210
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1111
Practice Address - Country:US
Practice Address - Phone:805-242-3045
Practice Address - Fax:855-932-2034
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-11
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK104729106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist