Vencent Gardner
Individual provider Active NPI Social Worker · Forest Hill, TX
NPI 1831945195 · NPPES record last updated Apr 27, 2024
Key facts
- NPI
- 1831945195
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 111544 (TX)
- Practice address
- 3101 Autumn Run Dr
Forest Hill, TX 76140-1927 - Phone
- (817) 291-0722
- NPI assigned
- Apr 27, 2024
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 111544 | TX | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 111544 | TX | Yes |
Addresses
Primary practice location
3101 Autumn Run Dr
Forest Hill, TX 76140-1927
Mailing address
3101 Autumn Run Dr
Forest Hill, TX 76140-1927
Other providers in Forest Hill, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 27, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.