| Doctor Name: | MS. EUNICE GRACE GARDNER |
| NPI Number: | 1003128265 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | |
| Business Practice Address: | 777 Hospital Way Pocatello, ID - 832015175 |
| Business Phone Number: | 2082391710 |
| Business Fax Number: | |
| Mailing Address: | 777 Hospital Way, POCATELLO |
| State: | ID |
| Postal Code: | 832015175 |
| Phone Number: | 2082391710 |
| Fax Number: | |
| NPI Enumeration Date: | 07/05/2010 |
| NPI Last Update Date: | 10/24/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TB0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Cognitive & Behavioral |
| Taxonomy Definition: | |