| Doctor Name: | KEITH WAYNE GARDNER |
| NPI Number: | 1649612615 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LMSW |
| License Number: | 03178 |
| Business Practice Address: | 1003 Cottonwood Rd Creston, IA - 508011012 |
| Business Phone Number: | 6417828457 |
| Business Fax Number: | |
| Mailing Address: | 705 W Filmore St, WINTERSET |
| State: | IA |
| Postal Code: | 502731046 |
| Phone Number: | 5154190066 |
| Fax Number: | |
| NPI Enumeration Date: | 07/19/2013 |
| NPI Last Update Date: | 07/19/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 03178 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |