Provider Demographics
NPI:1578455093
Name:GARDNER, SETH (SLP)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:GARDNER
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 COUNTRY RUN WAY
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-5907
Mailing Address - Country:US
Mailing Address - Phone:724-549-3579
Mailing Address - Fax:
Practice Address - Street 1:1 FREDERICK HEALTH WAY
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-9435
Practice Address - Country:US
Practice Address - Phone:240-566-3568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11015235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist