Provider Demographics
NPI:1871081232
Name:CARDINAL, JENNIFER EVAN (LMSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:EVAN
Last Name:CARDINAL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:EVAN
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:306 S INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-2352
Mailing Address - Country:US
Mailing Address - Phone:816-380-4010
Mailing Address - Fax:816-887-5703
Practice Address - Street 1:306 S INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-2352
Practice Address - Country:US
Practice Address - Phone:816-380-4010
Practice Address - Fax:816-887-5703
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MO2012008147104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical