Provider Demographics
NPI:1699852301
Name:BARDEN, JENNIFER A (MS, PT,LAT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:BARDEN
Suffix:
Gender:F
Credentials:MS, PT,LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 KENWOOD DR STE B
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-2949
Mailing Address - Country:US
Mailing Address - Phone:715-841-0002
Mailing Address - Fax:715-841-0003
Practice Address - Street 1:3200 WESTHILL DR STE 201
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4707
Practice Address - Country:US
Practice Address - Phone:715-847-2382
Practice Address - Fax:715-847-2381
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
WI5808-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5808-024OtherSTATE LIC. NUMBER