Provider Demographics
NPI:1316968894
Name:WENIGER, JENNIFER LOUISE (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LOUISE
Last Name:WENIGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 BARTON RD.
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92372
Mailing Address - Country:US
Mailing Address - Phone:909-558-9325
Mailing Address - Fax:909-825-8568
Practice Address - Street 1:LOMA LINDA BEHAVIORAL MEDICINE CENTER
Practice Address - Street 2:1710 BARTON RD.
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:72372
Practice Address - Country:US
Practice Address - Phone:909-558-9325
Practice Address - Fax:909-825-8568
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38238106H00000X
CAPSY23650103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist