Healthcare Provider Details

I. General information

NPI: 1588270433
Provider Name (Legal Business Name): JENNIFER D WAHR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE # 7M
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

4900 SHATTUCK AVE UNIT 3164
OAKLAND CA
94609-7005
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-8426
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number106594
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: