Provider Demographics
NPI:1538995899
Name:HARDIN, JACLYN L
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:L
Last Name:HARDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 SOUTHRIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47448-9790
Mailing Address - Country:US
Mailing Address - Phone:812-345-5654
Mailing Address - Fax:
Practice Address - Street 1:533 SOUTHRIDGE TRL
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IN
Practice Address - Zip Code:47448-9790
Practice Address - Country:US
Practice Address - Phone:812-345-5654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99127243A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health