Jennifer Joan Tanner, LICSW, SUDP

Primary specialty

Social WorkerTaxonomy code 104100000X

License

LW61682475 Issued in WA

Practice address

4111 Alderwood Mall Blvd
Lynnwood, WA 98036-6765

Phone

(425) 977-2560

NPI assigned

Nov 27, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1543276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754006400000",
    "number": "1316417827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4111 ALDERWOOD MALL BLVD",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980366765",
            "telephone_number": "425-977-2560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4111 ALDERWOOD MALL BLVD",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980366765",
            "telephone_number": "425-977-2560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANNER",
        "first_name": "JENNIFER",
        "middle_name": "JOAN",
        "credential": "LICSW, SUDP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-27",
        "last_updated": "2025-08-01",
        "certification_date": "2025-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP60717858",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WA",
            "license": "LW61682475",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zachary Noah Tanaid, MSW
• Kyle C Tanaka, DDS
• Serena Tang
• Tingting Tang
• Selma Tanjo, DNP, ARNP, FNP-BC
• Chloe Tarabocchia
• Hangama Tarshi, PHARMD
• Edwin Lee Tat, DPT
• Linda Tatta, LICSW
• Kathy Regla Tavia

• Social Worker in Lynnwood, WA
• Providers in Lynnwood, WA by specialty
• Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.