Provider Demographics
NPI:1053794933
Name:HARKENRIDER, JACQUELINE MATTICK (MS CGC)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:MATTICK
Last Name:HARKENRIDER
Suffix:
Gender:F
Credentials:MS CGC
Other - Prefix:MS
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:MATTICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CGC
Mailing Address - Street 1:6431 FANNIN
Mailing Address - Street 2:MSB 3.286
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-486-2286
Mailing Address - Fax:
Practice Address - Street 1:6410 FANNIN ST STE 360
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3002
Practice Address - Country:US
Practice Address - Phone:713-486-2286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS