Individual
SUSAN J LICOAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
39 3301 MILO PLACE, OOKALA, HI 96774
(808) 896-7186
(808) 962-6943
Mailing address
PO BOX 1578, HONOKAA, HI 96727-1578
(808) 896-7186
(808) 962-6943
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1214
HI
Other
Enumeration date
11/04/2010
Last updated
05/12/2013
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