1396865572 NPI number — MS. WENDY LOIS WEGEFORTH M.A., LMFT

Table of content: MS. WENDY LOIS WEGEFORTH M.A., LMFT (NPI 1396865572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396865572 NPI number — MS. WENDY LOIS WEGEFORTH M.A., LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEGEFORTH
Provider First Name:
WENDY
Provider Middle Name:
LOIS
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHARFAUROS
Provider Other First Name:
WENDY
Provider Other Middle Name:
LOIS
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
B.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396865572
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1885 THE ALAMEDA
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95126-1744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-888-6630
Provider Business Mailing Address Fax Number:
408-244-7266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1885 THE ALAMEDA
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95126-1744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-888-6630
Provider Business Practice Location Address Fax Number:
408-244-7266
Provider Enumeration Date:
03/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC42175 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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