Healthcare Provider Details

I. General information

NPI: 1427983311
Provider Name (Legal Business Name): JILL A HARDEE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 S WILLOW ST STE A
KENAI AK
99611-6940
US

IV. Provider business mailing address

PO BOX 7501
NIKISKI AK
99635-7501
US

V. Phone/Fax

Practice location:
  • Phone: 907-598-3470
  • Fax:
Mailing address:
  • Phone: 907-598-3470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number106123
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: