Provider Demographics
NPI:1962832642
Name:WEED, JESSIE L (MS, CNIM)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:L
Last Name:WEED
Suffix:
Gender:F
Credentials:MS, CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12337 JONES RD
Mailing Address - Street 2:SUITE 427
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4800
Mailing Address - Country:US
Mailing Address - Phone:832-912-8603
Mailing Address - Fax:
Practice Address - Street 1:12337 JONES RD
Practice Address - Street 2:SUITE 427
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4800
Practice Address - Country:US
Practice Address - Phone:832-912-8603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2775246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic