Individual
JENNIFER DEEKER WARDLOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
12 W SUNBRIDGE DR, FAYETTEVILLE, AR 72703-1822
(479) 750-2020
(479) 872-2441
Mailing address
PO BOX 6430, SPRINGDALE, AR 72766-6430
(479) 750-2020
(479) 872-2441
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1836-M
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5X705
AR BLUE CROSS #
AR
Enumeration date
09/02/2006
Last updated
07/08/2007
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