Provider Demographics
NPI:1902326796
Name:CHAN, JENIFER WENDY (LMFT)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:WENDY
Last Name:CHAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 PRICE AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1403
Mailing Address - Country:US
Mailing Address - Phone:650-366-8436
Mailing Address - Fax:
Practice Address - Street 1:340 LORTON AVE STE 205
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4126
Practice Address - Country:US
Practice Address - Phone:457-763-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health