Provider Demographics
NPI:1316085079
Name:JARDINE, SANDY (MS)
Entity type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:
Last Name:JARDINE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2649 E. BEEKMAN PL.
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016
Mailing Address - Country:US
Mailing Address - Phone:480-990-9128
Mailing Address - Fax:602-840-5255
Practice Address - Street 1:2649 E. BEEKMAN PL.
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016
Practice Address - Country:US
Practice Address - Phone:480-990-9128
Practice Address - Fax:602-840-5255
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0556101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional