Provider Demographics
NPI:1326826272
Name:JARDINE, ANN LOUISE (CLINICAL SOCIAL WORK)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:LOUISE
Last Name:JARDINE
Suffix:
Gender:F
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ICE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-9652
Mailing Address - Country:US
Mailing Address - Phone:440-823-1235
Mailing Address - Fax:
Practice Address - Street 1:10 ICE LAKE DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN TOP
Practice Address - State:PA
Practice Address - Zip Code:18707-9652
Practice Address - Country:US
Practice Address - Phone:440-823-1235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.07001591041C0700X
PACW0174411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical