Provider Demographics
NPI:1164007159
Name:DEJONG, HESTER
Entity Type:Individual
Prefix:
First Name:HESTER
Middle Name:
Last Name:DEJONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 W DALLAS ST APT 374
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-4095
Mailing Address - Country:US
Mailing Address - Phone:832-693-8227
Mailing Address - Fax:
Practice Address - Street 1:2900 W DALLAS ST APT 374
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-4095
Practice Address - Country:US
Practice Address - Phone:832-693-8227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX588281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty