Provider Demographics
NPI:1205063989
Name:GARDER, DAVID LEONID (MS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LEONID
Last Name:GARDER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1672 OXFORD ST
Mailing Address - Street 2:12A
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-1642
Mailing Address - Country:US
Mailing Address - Phone:845-405-1603
Mailing Address - Fax:
Practice Address - Street 1:2701 N ROCKY POINT DR
Practice Address - Street 2:SUITE 650
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5917
Practice Address - Country:US
Practice Address - Phone:845-405-1603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist