Provider Demographics
NPI:1609761667
Name:GARDNER, JENNA ANN (LMSW)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:ANN
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 N 40TH ST APT 35
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-1426
Mailing Address - Country:US
Mailing Address - Phone:602-628-2457
Mailing Address - Fax:
Practice Address - Street 1:21803 N SCOTTSDALE RD UNIT 110
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7438
Practice Address - Country:US
Practice Address - Phone:602-628-2457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-219681041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool