Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner | ||
Y | 225C00000X | Rehabilitation Counselor | CA |
NPI | 1093159600 |
---|---|
Provider Name | Ms. Tselane L. Gardner |
First Address | Pasadena, CA 91101-1403 |
Second Address | Pasadena, CA 91101-1403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2013 |
Last Update Date | 22/07/2019 |