MEDICARE: JENIFER KRISTEN LUDWIG MS, LMFT

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	85436	CA
2	106H00000X	Marriage & Family Therapist	121125	CA

General Provider Information

NPI Number	:	1093188427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENIFER KRISTEN LUDWIG MS, LMFT

Provider Business Mailing Address
First Line	:	5027 DEL MONTE AVE APT 10
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92107-6230
Country	:	US
Telephone Number	:	951-941-9392
Fax Number	:

Provider Business Practice Location Address
First Line	:	3737 MORAGA AVE STE A203
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-5491
Country	:	US
Telephone Number	:	619-363-1920
Fax Number	:	619-363-4326

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

Provider Enumeration Date	:	11/06/2015
Last Update Date	:	03/27/2021

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