Provider Demographics
NPI:1013218478
Name:REARDEN, JENNIFER WHITT (LGSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:WHITT
Last Name:REARDEN
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 9TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:CHILDERSBURG
Mailing Address - State:AL
Mailing Address - Zip Code:35044-1231
Mailing Address - Country:US
Mailing Address - Phone:205-266-8043
Mailing Address - Fax:205-378-3371
Practice Address - Street 1:151 9TH AVE NW
Practice Address - Street 2:
Practice Address - City:CHILDERSBURG
Practice Address - State:AL
Practice Address - Zip Code:35044-1231
Practice Address - Country:US
Practice Address - Phone:205-266-8043
Practice Address - Fax:205-378-3371
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2136G104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker