Healthcare Provider Details

I. General information

NPI: 1871733691
Provider Name (Legal Business Name): JENNY GARDON, LICSW, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

753 N 35TH ST OFFICE 304
SEATTLE WA
98103-8870
US

IV. Provider business mailing address

753 N 35TH ST OFFICE 304
SEATTLE WA
98103-8870
US

V. Phone/Fax

Practice location:
  • Phone: 206-634-1642
  • Fax:
Mailing address:
  • Phone: 206-634-1642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNY GARDON
Title or Position: PRESIDENT
Credential: MSW, LICSW
Phone: 206-634-1642