Provider Demographics
NPI:1144851213
Name:STEIN, JESSICA MEREDITH (LAC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MEREDITH
Last Name:STEIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:
Other - Last Name:STEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:1901 POST OAK PARK DR APT 10104
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-3363
Mailing Address - Country:US
Mailing Address - Phone:972-903-2566
Mailing Address - Fax:
Practice Address - Street 1:2001 KATY MILLS BLVD STE I
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-4880
Practice Address - Country:US
Practice Address - Phone:832-913-8186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2021-07-15
Deactivation Date:2021-01-26
Deactivation Code:
Reactivation Date:2021-07-15
Provider Licenses
StateLicense IDTaxonomies
TXAC01908171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist