Active NPI
Jeanine Wong
- Marriage & Family Therapist
- Santa Rosa, CA
National Provider Identifier
1639565104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- Practice address
- 3329 Bonita Vista Lane
Santa Rosa, CA 95404 - Phone
- (707) 978-9209
- NPI assigned
- Apr 12, 2015
- 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | Primary |
Addresses
Primary practice location
3329 Bonita Vista Lane
Santa Rosa, CA 95404
Mailing address
3329 Bonita Vista Lane
Santa Rosa, CA 95404
Phone (808) 754-8235
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1428796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623715200000",
"number": "1639565104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3329 BONITA VISTA LANE",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "95404",
"telephone_number": "808-754-8235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3329 BONITA VISTA LANE",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "95404",
"telephone_number": "707-978-9209"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "JEANINE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-04-12",
"last_updated": "2021-06-15",
"certification_date": "2021-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.