Healthcare Provider Details

I. General information

NPI: 1386651636
Provider Name (Legal Business Name): JEANNE NEWTON LANGSTON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 01/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 SPICEWOOD SPRINGS RD SUITE M-2
AUSTIN TX
78759-8661
US

IV. Provider business mailing address

4200 RIVER PLACE BLVD
AUSTIN TX
78730-3537
US

V. Phone/Fax

Practice location:
  • Phone: 512-217-8121
  • Fax: 512-342-2931
Mailing address:
  • Phone: 512-217-8121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number31685
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number31685
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: