MEDICARE: MRS. LEENETTE MARIE JUPITER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	33407	TX

General Provider Information

NPI Number	:	1588334502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEENETTE MARIE JUPITER

Provider Business Mailing Address
First Line	:	3840 BRIARCHASE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77014-2755
Country	:	US
Telephone Number	:	281-891-8465
Fax Number	:

Provider Business Practice Location Address
First Line	:	16717 ELLA BLVD # 11
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-4213
Country	:	US
Telephone Number	:	281-891-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2021
Last Update Date	:	09/20/2021

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