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NPI Code Detail

MEDICARE: DR. JENNY SHIELDS

MEDICARE: DR. JENNY SHIELDS
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
1103TC0700XClinical Psychologist40268TX
2103TH0100XHealth Service Psychologist1359OK
3174V00000XClinical Ethicist129889TX
4174V00000XClinical Ethicist129889OK
5103TH0100XHealth Service Psychologist40268TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558998377
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JENNY SHIELDS
Provider Business Mailing Address
First Line : 8708 TECHNOLOGY FOREST PL STE 175
Second Line :
City : THE WOODLANDS
State : TX
Zip : 77381-1183
Country : US
Telephone Number : 713-482-1925
Fax Number :
Provider Business Practice Location Address
First Line : 8708 TECHNOLOGY FOREST PL STE 175
Second Line :
City : THE WOODLANDS
State : TX
Zip : 77381-1183
Country : US
Telephone Number : 713-482-1925
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2020
Last Update Date : 04/30/2025

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Directions to “ DR. JENNY SHIELDS ” Practice Location

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