Provider Demographics
NPI:1376996421
Name:NICHOLE L JARDINE LCSW PLLC
Entity Type:Organization
Organization Name:NICHOLE L JARDINE LCSW PLLC
Other - Org Name:NICKY JARDINE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JARDINE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:435-213-3583
Mailing Address - Street 1:5991 BELL ST SE
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-5355
Mailing Address - Country:US
Mailing Address - Phone:435-232-7995
Mailing Address - Fax:435-753-9521
Practice Address - Street 1:5991 BELL ST SE
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-5355
Practice Address - Country:US
Practice Address - Phone:435-232-7995
Practice Address - Fax:435-753-9521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8977595-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty