Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 54216 | TX |
NPI | 1003169764 |
---|---|
Provider Name | Jeanne Dewey |
First Address | Houston, TX 77006-5015 |
Second Address | Houston, TX 77006-5015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2012 |
Last Update Date | 18/10/2012 |