Provider Demographics
NPI:1700104023
Name:GARDNER, BRIE (MS, SLP-CCC)
Entity type:Individual
Prefix:
First Name:BRIE
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15809 BEAR CREEK PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-1542
Mailing Address - Country:US
Mailing Address - Phone:425-882-6100
Mailing Address - Fax:
Practice Address - Street 1:15809 BEAR CREEK PKWY STE 100
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-1542
Practice Address - Country:US
Practice Address - Phone:425-225-6330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60112020235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist