MEDICARE: MS. JANE ELIZABETH BOOTH 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	103G00000X	Clinical Neuropsychologist	32779	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1932119575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANE ELIZABETH BOOTH PHD

Provider Business Mailing Address
First Line	:	13201 NORTHWEST FWY STE 668
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-6237
Country	:	US
Telephone Number	:	281-513-5311
Fax Number	:

Provider Business Practice Location Address
First Line	:	13201 NORTHWEST FWY STE 668
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-6237
Country	:	US
Telephone Number	:	713-487-5882
Fax Number	:

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	04/16/2024

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