Provider Demographics
NPI:1336472679
Name:JARDINE, DANIEL J (LCSW)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:JARDINE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 AUGUSTA LN
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-3472
Mailing Address - Country:US
Mailing Address - Phone:208-569-8920
Mailing Address - Fax:
Practice Address - Street 1:1490 GRIMES ST
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-3103
Practice Address - Country:US
Practice Address - Phone:775-423-1412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6287-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical