Jill Marie Tiedeman, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

109807 Issued in CA

Practice address

5903 Montauk Way
Stockton, CA 95219-7282

Phone

(209) 986-3672

NPI assigned

Aug 12, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Jill Marie Solari Other name

Electronic endpoints 1

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": "1281571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727827200000",
    "number": "1154636389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5903 MONTAUK WAY",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952197282",
            "telephone_number": "209-986-3672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5903 MONTAUK WAY",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952197282",
            "telephone_number": "209-986-3672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIEDEMAN",
        "first_name": "JILL",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-12",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "109807",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4700 Enterprise Wy.",
            "city": "Modesto",
            "state": "CA",
            "country_code": "US",
            "postal_code": "95356",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JILL",
            "last_name": "SOLARI",
            "middle_name": "MARIE",
            "prefix": "MRS.",
            "credential": "LMFT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Raksmey Tiano, PHD
• Janessa Tibbot, RBT
• Jennifer Leann Tibbot, RBT
• Stephanie Renee Tickemyer
• Stacey Tidwell, LCSW
• Tien Trong Vu, M.D. Inc.
• Jose Tienda, MS,ATC,CES
• Pedro Tienda Jr.
• Elise Tieu, BS
• Brittany Tilford

• Marriage & Family Therapist in Stockton, CA
• Providers in Stockton, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2024; 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.