Provider Demographics
NPI:1528825668
Name:JACKSON-DEAN, LASHONDA MICHILL (DM, MBA, CPT, CIVT)
Entity type:Individual
Prefix:DR
First Name:LASHONDA
Middle Name:MICHILL
Last Name:JACKSON-DEAN
Suffix:
Gender:F
Credentials:DM, MBA, CPT, CIVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11722 CABOT HILL ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-5500
Mailing Address - Country:US
Mailing Address - Phone:713-791-2806
Mailing Address - Fax:
Practice Address - Street 1:11811 EAST FWY STE 325
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77029-1982
Practice Address - Country:US
Practice Address - Phone:832-384-6792
Practice Address - Fax:877-384-2805
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN24104580202K00000X, 246RP1900X
TX41B020231215251F00000X
TX45D2301278291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No251F00000XAgenciesHome Infusion
No291U00000XLaboratoriesClinical Medical Laboratory