Provider Demographics
NPI:1295775617
Name:RAIZNER, RANDI D (PHD)
Entity type:Individual
Prefix:DR
First Name:RANDI
Middle Name:D
Last Name:RAIZNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12946 DAIRY ASHFORD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478
Mailing Address - Country:US
Mailing Address - Phone:713-256-1157
Mailing Address - Fax:346-309-2331
Practice Address - Street 1:12946 DAIRY ASHFORD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478
Practice Address - Country:US
Practice Address - Phone:713-256-1157
Practice Address - Fax:346-309-2331
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32376103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172605101Medicaid
TX87100AOtherBCBS
TX8E0429Medicare PIN
TX87100AOtherBCBS