Individual
GWEN MIKASA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
OFFICE OF STUDENT SUPPORT MEDICAID REIMBURSEMENT, 475 22ND AVE, BLDG 302, ROOM 101, HONOLULU, HI 96816
(808) 305-9750
Mailing address
OFFICE OF STUDENT SUPPORT MEDICAID REIMBURSEMENT, 475 22ND AVE, BLDG 302, ROOM 101, HONOLULU, HI 96816
(808) 305-9750
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
657
HI
Other
Enumeration date
09/04/2019
Last updated
09/04/2019
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