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JESSICA KIESENDAHL MFT
NPI 1790817682
Marriage & Family Therapist in San Dimas, CA

Active since March 09, 2007PECOS Enrolled
762 W CYPRESS AVE, SAN DIMAS, CA 91773(909) 599-1227(909) 599-4157 Get Directions Write a Review

NPPES record last updated: December 9, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Dec 9, 2024, Dec 6, 2024, Sep 14, 2018 (3 updates tracked since 2018).

About Jessica Kiesendahl Mft NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JESSICA KIESENDAHL MFT (NPI 1790817682) is an individual marriage & family therapist in San Dimas, California, licensed in California (80216) and active in the NPI registry since March 2007. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1790817682
Entity TypeIndividualFemale
Primary Taxonomy106H00000X
Provider Legal NameJESSICA KIESENDAHLCredential: MFT
Location Address762 W CYPRESS AVESan Dimas, CA 91773-3505
Mailing Address762 W Cypress AveSan Dimas, CA 91773-3505 · (909) 599-1227 · Fax (909) 599-4157
Phone(909) 599-1227
Fax(909) 599-4157
Sole ProprietorNo
Enumeration DateMarch 9, 2007
Last NPPES UpdateDecember 9, 20243 updates tracked since enumeration
NPPES CertifiedDecember 9, 2024
✔ NPI 1790817682 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers
Taxonomy Code106H00000X
License✔ Licensed in CA · 80216
Definition
A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X
762 W CYPRESS AVE, San Dimas, CA 91773
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Other Names 1

Former Name (1)Miss Jessica Williams B.a., Mft

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jessica Kiesendahl Mft is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Jessica Kiesendahl reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Southern California Permanente Medical Group
6.8 mi
Clinical Medical Laboratory
13000 PEYTON DR
Chino Hills, CA 91709
  • Reassigned Medicare billing, California enrollment
  • 5,228 clinicians in this Medicare group
NPI 1396287082 (888) 750-0036

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 19

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. SUSANA MATA-NUNEZ LVN
Licensed Vocational Nurse
762 W CYPRESS AVE
SAN DIMAS, CA 91773
Los Angeles County (909) 599-1227
CYNTHIA CARLEEN GONZALEZ MSW
Social Worker (Clinical)
762 W CYPRESS AVE
SAN DIMAS, CA 91773
Los Angeles County (909) 599-1227
MRS. PARISS NICOLE PACHECO LVN
Licensed Vocational Nurse
762 W CYPRESS AVE
SAN DIMAS, CA 91773
Los Angeles County (909) 599-1227
MR. DEREK JAMES AUGARTEN
Rehabilitation Practitioner
762 W CYPRESS AVE
SAN DIMAS, CA 91773
Los Angeles County (909) 599-1227
MR. LARRY MURPHEY
Counselor
762 W CYPRESS AVE
SAN DIMAS, CA 91773
Los Angeles County (909) 599-1227
LAMONT DESHAWN LANDERS B.S
Counselor
762 W CYPRESS AVE
SAN DIMAS, CA 91773
Los Angeles County (909) 599-1227
MISS ANDREA LEE MOZELLE
Counselor (Mental Health)
762 W CYPRESS AVE
SAN DIMAS, CA 91773
Los Angeles County (909) 599-1227
JENNIFER LEITMEYER LMFT
Marriage & Family Therapist
762 W CYPRESS AVE
SAN DIMAS, CA 91773
Los Angeles County (909) 599-1227

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jessica Kiesendahl's NPI number?

The NPI number for Jessica Kiesendahl is 1790817682. It was assigned to this individual provider in the NPPES registry on March 9, 2007. The provider is also known as Miss Jessica Williams B.A., Mft.

Where is Jessica Kiesendahl located?

Jessica Kiesendahl practices at 762 W Cypress Ave, San Dimas, CA 91773. The listed phone number is (909) 599-1227.

What is Jessica Kiesendahl's specialty?

The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.

Is Jessica Kiesendahl enrolled in Medicare?

Yes. Jessica Kiesendahl is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jessica Kiesendahl's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jessica Kiesendahl reassigns Medicare benefits to Southern California Permanente Medical Group (Chino Hills, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jessica Kiesendahl's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jessica Kiesendahl was last updated on December 9, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.