Healthcare Provider Details

I. General information

NPI: 1235497090
Provider Name (Legal Business Name): STEPHANIE JANE HOUSTON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE JANE BEAN

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8605 CHAMBERY BLVD
JOHNSTON IA
50131-8810
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 515-457-2960
  • Fax: 515-457-2961
Mailing address:
  • Phone: 319-356-4920
  • Fax: 319-384-9616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO-05033
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberDO-05033
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: