Healthcare Provider Details

I. General information

NPI: 1336051762
Provider Name (Legal Business Name): JESSICA WANG LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 W FREMONT AVE
SUNNYVALE CA
94087-2593
US

IV. Provider business mailing address

575 W FREMONT AVE
SUNNYVALE CA
94087-2593
US

V. Phone/Fax

Practice location:
  • Phone: 408-522-2476
  • Fax:
Mailing address:
  • Phone: 408-522-2476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number91335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: