Provider Demographics
NPI:1407669377
Name:DOCKSTADER, HEATHER SUE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:SUE
Last Name:DOCKSTADER
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 1:6303 PICKENS ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-2171
Mailing Address - Country:US
Mailing Address - Phone:936-697-6427
Mailing Address - Fax:
Practice Address - Street 1:6303 PICKENS ST UNIT B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-2171
Practice Address - Country:US
Practice Address - Phone:936-697-6427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist