| Nicky Jardine | |
|
5991 Bell St Se Tumwater WA 98501-5355 | |
| (435) 232-7995 | |
| (435) 753-9521 |
| Full Name | Nicky Jardine |
|---|---|
| Speciality | Social Worker |
| Location | 5991 Bell St Se, Tumwater, Washington |
| Authorized Official Name and Position | Nichole L Jardine (OWNER) |
| Authorized Official Contact | 4352133583 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nicky Jardine 5991 Bell St Se Tumwater WA 98501-5355 Ph: (435) 232-7995 | Nicky Jardine 5991 Bell St Se Tumwater WA 98501-5355 Ph: (435) 232-7995 |
| NPI Number | 1376996421 |
|---|---|
| Provider Enumeration Date | 07/13/2016 |
| Last Update Date | 08/22/2022 |
| Certification Date | 08/19/2022 |
| Medicare PECOS PAC ID | 0042598377 |
|---|---|
| Medicare Enrollment ID | O20161020001873 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376996421 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 8977595-3501 (Utah) | Primary |
| Provider Name | Nichole L Jardine |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003266206 PECOS PAC ID: 0840381141 Enrollment ID: I20161024002446 |
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