Provider Demographics
NPI:1831309640
Name:DOSTER, JEANETTE ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:ANN
Last Name:DOSTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 SHADOW CREEK CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-3400
Mailing Address - Country:US
Mailing Address - Phone:682-667-6505
Mailing Address - Fax:
Practice Address - Street 1:2205 SHADOW CREEK CT
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-3400
Practice Address - Country:US
Practice Address - Phone:682-667-6505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21708103TC2200X
TX6463103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool