Andrea Gardner

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

A5485 Issued in OR

Practice address

5100 SW Macadam Ave
Suite 400
Portland, OR 97239-6102

Phone

(971) 244-1363

NPI assigned

Nov 4, 2015

Last updated

Nov 4, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lines for Life

  • Community/Behavioral Health Agency
  • Portland, OR
  • NPI 1891246070
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1446595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446595200000",
    "number": "1073986659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 SW MACADAM AVE",
            "address_2": "SUITE 400",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972396102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 SW MACADAM AVE",
            "address_2": "SUITE 400",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972396102",
            "telephone_number": "971-244-1363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "ANDREA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-04",
        "last_updated": "2015-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OR",
            "license": "M5485",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "A5485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miles Gardiner
• Sara Kathryn Gardiner, MD
• Stephanie Gardiner, NP
• Tessa Mae Gardiner
• Tara Gardner-Brown, NP-C
• Ashley Gardner, M.D., M.S., PHD
• Daniella Gardner, RD
• Elizabeth Brie Gardner, MSW
• Hayley Elana Gardner, LAC
• Jessica Amy Gardner, L.M.T.

• Clinical Social Worker in Portland, OR
• Providers in Portland, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.