Provider Demographics
NPI:1538559984
Name:GARDNER, CHAD (MSW)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:GARDNER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1173 S WASHBURN ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-8053
Mailing Address - Country:US
Mailing Address - Phone:920-385-1420
Mailing Address - Fax:920-519-0063
Practice Address - Street 1:1173 S WASHBURN ST
Practice Address - Street 2:SUITE H
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-8053
Practice Address - Country:US
Practice Address - Phone:920-385-1420
Practice Address - Fax:920-519-0063
Is Sole Proprietor?:No
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI128713-1211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical