Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-15-18756 | HI |
NPI | 1003291972 |
---|---|
Provider Name | Jaclyn Joe |
First Address | Honolulu, HI 96825-4153 |
Second Address | Honolulu, HI 96825-4153 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2015 |
Last Update Date | 21/07/2015 |