Provider Demographics
NPI:1023570686
Name:GARDNER, JENNIFER F (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:F
Last Name:GARDNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21231
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35402-1231
Mailing Address - Country:US
Mailing Address - Phone:205-366-3010
Mailing Address - Fax:205-366-3012
Practice Address - Street 1:115 HARPER COURT
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-1250
Practice Address - Country:US
Practice Address - Phone:205-366-3010
Practice Address - Fax:205-366-3012
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1019103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist