Jenna Van Wagner, M.S.

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

59669 Issued in CA

Practice address

5240 Dahlia Dr
Los Angeles, CA 90041-1407

Phone

(310) 428-3768

NPI assigned

Oct 12, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Ms. Jenna Flowerree Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1255305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676332800000",
    "number": "1386979185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5240 DAHLIA DR",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900411407",
            "telephone_number": "310-428-3768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5240 DAHLIA DR",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900411407",
            "telephone_number": "310-428-3768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN WAGNER",
        "first_name": "JENNA",
        "name_prefix": "Mrs.",
        "credential": "M.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-12",
        "last_updated": "2023-02-14",
        "certification_date": "2023-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "LMFT77695",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "59669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNA",
            "last_name": "FLOWERREE",
            "prefix": "MS.",
            "credential": "M.S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Crystal Van Sickle
• Stephanie Van Stralen, PSY.D.
• Michael Merrell Van Tienderen, DO
• Jan Marie-Albert Van Tornout, MD
• John Derek Van Vessem IV, DO
• Sandra Van Wijk, MS, CCC-SLP
• David Van Zak, PSY. D.
• Adriaan J Van Zyl, AMFT
• Carin Van Zyl, M.D.
• Anderson Van, RPH

• Marriage & Family Therapist in Los Angeles, CA
• Providers in Los Angeles, 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 Feb 14, 2023; 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.