MEDICARE: HEATHER SMITH WINGREN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1841405669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER SMITH WINGREN

Provider Business Mailing Address
First Line	:	3016 CASTLE ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-3004
Country	:	US
Telephone Number	:	323-932-0316
Fax Number	:

Provider Business Practice Location Address
First Line	:	4311 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3708
Country	:	US
Telephone Number	:	323-932-0316
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/08/2007

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Directions to “ HEATHER SMITH WINGREN ” Practice Location

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