Provider Demographics
NPI:1871733691
Name:JENNY GARDON, LICSW, INC.
Entity type:Organization
Organization Name:JENNY GARDON, LICSW, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:206-634-1642
Mailing Address - Street 1:753 N 35TH ST
Mailing Address - Street 2:OFFICE 304
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8870
Mailing Address - Country:US
Mailing Address - Phone:206-634-1642
Mailing Address - Fax:
Practice Address - Street 1:753 N 35TH ST
Practice Address - Street 2:OFFICE 304
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8870
Practice Address - Country:US
Practice Address - Phone:206-634-1642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health