Provider Demographics
NPI:1558998377
Name:SHIELDS, JENNIFER DAER
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:DAER
Last Name:SHIELDS
Suffix:
Gender:
Credentials:
Other - Prefix:DR
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:SHIELDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8708 TECHNOLOGY FOREST PL # 114
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-1179
Mailing Address - Country:US
Mailing Address - Phone:713-482-1925
Mailing Address - Fax:
Practice Address - Street 1:8708 TECHNOLOGY FOREST PL # 114
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-1179
Practice Address - Country:US
Practice Address - Phone:713-482-1925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX129889174V00000X
TX40268103TH0100X, 103TC0700X
OK1359103TH0100X
OK129889174V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No174V00000XOther Service ProvidersClinical Ethicist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1558998377Medicaid