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General NPI Number Information
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NPI Number | 1871733691
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Entity Type | Organization
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Legal Business Name | JENNY GARDON, LICSW, INC.
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Dates
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Enumeration Date | 03/06/2009
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Last Update Date | 03/06/2009
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Provider Practice Location Address
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Address Line | 753 N 35TH ST OFFICE 304
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City | SEATTLE
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State | WA
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Zip | 98103-8870
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Country | US
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Telephone | 206-634-1642
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Fax |
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Provider Business Mailing Address
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Address Line | 753 N 35TH ST OFFICE 304
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City | SEATTLE
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State | WA
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Zip | 98103-8870
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Country | US
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Telephone | 206-634-1642
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. JENNY GARDON
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Credential | MSW, LICSW
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Telephone | 206-634-1642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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