Healthcare Provider Details

I. General information

NPI: 1013969641
Provider Name (Legal Business Name): JENNIFER M CARD LICSW, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 S WORTHEN ST
WENATCHEE WA
98801-3081
US

IV. Provider business mailing address

805 11TH ST NE
EAST WENATCHEE WA
98802-4505
US

V. Phone/Fax

Practice location:
  • Phone: 509-662-6761
  • Fax:
Mailing address:
  • Phone: 907-441-6069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number628
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW106716
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-10-7219
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: