Provider Demographics
NPI:1932411188
Name:GARDNER, VICKI SUE
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:SUE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2735 E TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1135
Mailing Address - Country:US
Mailing Address - Phone:907-762-8670
Mailing Address - Fax:907-562-7901
Practice Address - Street 1:2735 E. TUDOR ROAD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1347
Practice Address - Country:US
Practice Address - Phone:907-762-8670
Practice Address - Fax:907-562-7901
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-03
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker