Provider Demographics
NPI:1003266206
Name:JARDINE, NICHOLE L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NICHOLE
Middle Name:L
Last Name:JARDINE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5991 BELL ST SE
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-5355
Mailing Address - Country:US
Mailing Address - Phone:435-213-3583
Mailing Address - Fax:
Practice Address - Street 1:5991 BELL ST SE
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-5355
Practice Address - Country:US
Practice Address - Phone:435-213-3583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW611798891041C0700X
UT8977595-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical