MEDICARE: DR. JENNY T. WANG PHD

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
1	103TC0700X	Clinical Psychologist	4002	NC
2	103TC0700X	Clinical Psychologist	37268	TX

General Provider Information

NPI Number	:	1871886846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNY T. WANG PHD

Provider Business Mailing Address
First Line	:	13010 TAYLORCREST ROAD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079
Country	:	US
Telephone Number	:	832-900-9262
Fax Number	:

Provider Business Practice Location Address
First Line	:	1888 STEBBINS DRIVE, SUITE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043
Country	:	US
Telephone Number	:	832-900-9262
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2011
Last Update Date	:	01/31/2019

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