Provider Demographics
NPI:1043453053
Name:JOHNSTON, JENNIFER ELISE (LAC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELISE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17711 HERITAGE CT
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-3301
Mailing Address - Country:US
Mailing Address - Phone:281-774-8199
Mailing Address - Fax:
Practice Address - Street 1:17045 EL CAMINO REAL
Practice Address - Street 2:SUITE 210
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2649
Practice Address - Country:US
Practice Address - Phone:281-774-8199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01152171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist