Provider Demographics
NPI:1275398125
Name:DARDEN, JENNIFER C
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:C
Last Name:DARDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 E MEADOW LAND DR
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-5632
Mailing Address - Country:US
Mailing Address - Phone:520-431-3338
Mailing Address - Fax:
Practice Address - Street 1:4240 S ARIZONA AVE STE 1039
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-4593
Practice Address - Country:US
Practice Address - Phone:602-935-9185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBACB1052822106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician