Provider Demographics
NPI:1659812204
Name:WEGNER, JENNY (MS, MFT)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:WEGNER
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13629 E LONGVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2447
Mailing Address - Country:US
Mailing Address - Phone:303-834-0190
Mailing Address - Fax:
Practice Address - Street 1:3600 S YOSEMITE ST STE 1050
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-1852
Practice Address - Country:US
Practice Address - Phone:303-834-0190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13407106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist