1932414158 NPI number — MS. JENNIFER WENTZ MFT

Table of content: MS. JENNIFER WENTZ MFT (NPI 1932414158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932414158 NPI number — MS. JENNIFER WENTZ MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WENTZ
Provider First Name:
JENNIFER
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCKAY
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932414158
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 GREGORY LN
Provider Second Line Business Mailing Address:
SUITE 33
Provider Business Mailing Address City Name:
PLEASANT HILL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94523-4982
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-827-9876
Provider Business Mailing Address Fax Number:
925-827-1008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 GREGORY LN
Provider Second Line Business Practice Location Address:
SUITE 33
Provider Business Practice Location Address City Name:
PLEASANT HILL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94523-4982
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-827-9876
Provider Business Practice Location Address Fax Number:
925-827-1008
Provider Enumeration Date:
08/12/2010

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:  MFC 44502 , 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)