Jennifer Deeker Wardlow, LMSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

1836-M Issued in AR

Practice address

12 W Sunbridge Dr
Fayetteville, AR 72703-1822

Phone

(479) 750-2020

Fax

(479) 872-2441

NPI assigned

Sep 2, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jennifer Deeker Former name

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": "1157155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1750483566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6430",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727666430",
            "telephone_number": "479-750-2020",
            "fax_number": "479-872-2441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 W SUNBRIDGE DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727031822",
            "telephone_number": "479-750-2020",
            "fax_number": "479-872-2441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARDLOW",
        "first_name": "JENNIFER",
        "middle_name": "DEEKER",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AR",
            "license": "1836-M",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AR BLUE CROSS #",
            "identifier": "5X705",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "DEEKER",
            "credential": "LMSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jeffrey Michael Ward, D.D.S.
• Tara L Ward
• Whitney Brooke Ward, APRN
• Rachel L Warden, LCSW
• Ashley Anne Wardlaw, LCSW
• Markese Ware
• Justin Ray Warix, D.O.
• Warren C. Massey, DDS, Ms. PA
• Amanda Nicole Warren, D.C.
• Andrea Warren

• Mental Health Counselor in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Mental Health Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.