Provider Demographics
NPI:1992435283
Name:HOAG WYDLER, JENNIFER (LCSW, LCDC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HOAG WYDLER
Suffix:
Gender:F
Credentials:LCSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 BRAZOSWOOD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78244-2817
Mailing Address - Country:US
Mailing Address - Phone:210-441-0221
Mailing Address - Fax:
Practice Address - Street 1:6333 DE ZAVALA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2115
Practice Address - Country:US
Practice Address - Phone:210-399-4838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13146101YA0400X
TX692501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)