Provider Demographics
NPI:1326118886
Name:HARDER, JENNIFER (CADC III)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:HARDER
Suffix:
Gender:F
Credentials:CADC III
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:WEAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1320 W CLAIREMONT AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4566
Mailing Address - Country:US
Mailing Address - Phone:718-834-2046
Mailing Address - Fax:715-834-7563
Practice Address - Street 1:405 S BARSTOW ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4896
Practice Address - Country:US
Practice Address - Phone:715-838-7043
Practice Address - Fax:715-838-7044
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11112101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39395400Medicaid