Healthcare Provider Details

I. General information

NPI: 1649463738
Provider Name (Legal Business Name): JENNIFER KAY HOUSTON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 HIGH FALLS RD
CATSKILL NY
12414-5604
US

IV. Provider business mailing address

1081 HIGH FALLS RD
CATSKILL NY
12414-5604
US

V. Phone/Fax

Practice location:
  • Phone: 518-678-3154
  • Fax: 518-678-5551
Mailing address:
  • Phone: 518-678-3154
  • Fax: 518-678-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number000440-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: