Active NPI
Jennifer Walton-Wetzel, LCSW
- Clinical Social Worker
- Port Costa, CA
National Provider Identifier
1033722863
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 96627
- Practice address
- 60 Canyon Lake Dr Ste 97
Port Costa, CA 94569-1000 - Phone
- (323) 741-6191
- NPI assigned
- Aug 31, 2020
- Last updated
- Apr 26, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 96627 | CA | Primary |
Addresses
Primary practice location
60 Canyon Lake Dr Ste 97
Port Costa, CA 94569-1000
Mailing address
60 Canyon Lake Dr Ste 97
Port Costa, CA 94569-1000
Phone (323) 741-6191
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 96627 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1745625600000",
"number": "1033722863",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "60 CANYON LAKE DR STE 97",
"city": "PORT COSTA",
"state": "CA",
"postal_code": "945691000",
"telephone_number": "323-741-6191"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "60 CANYON LAKE DR STE 97",
"city": "PORT COSTA",
"state": "CA",
"postal_code": "945691000",
"telephone_number": "323-741-6191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALTON-WETZEL",
"first_name": "JENNIFER",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-08-31",
"last_updated": "2025-04-26",
"certification_date": "2025-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "96627",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Costa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 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.