Provider Demographics
NPI:1578455929
Name:GARDNER, DARRICK JR (MS)
Entity type:Individual
Prefix:
First Name:DARRICK
Middle Name:
Last Name:GARDNER
Suffix:JR
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 1:415 GLENSPRINGS DR STE 301
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:45246-2354
Mailing Address - Country:US
Mailing Address - Phone:513-570-4068
Mailing Address - Fax:
Practice Address - Street 1:415 GLENSPRINGS DR STE 301
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:OH
Practice Address - Zip Code:45246-2354
Practice Address - Country:US
Practice Address - Phone:513-570-4068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty