Healthcare Provider Details

I. General information

NPI: 1376553594
Provider Name (Legal Business Name): JACQUELINE MIEKKA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9525 KATY FWY STE 210
HOUSTON TX
77024-1432
US

IV. Provider business mailing address

9525 KATY FWY STE 210
HOUSTON TX
77024-1432
US

V. Phone/Fax

Practice location:
  • Phone: 281-394-8876
  • Fax:
Mailing address:
  • Phone: 281-394-8876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number24604
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: