Individual
JENNIFER WAKELEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1895 HALEUKANA ST, LIHUE, HI 96766-9072
(808) 346-6690
(888) 461-0904
Mailing address
4151 MOMI ST, KILAUEA, HI 96754-5312
(808) 639-5896
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-211200
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-22-211200
BACB
—
Enumeration date
04/11/2022
Last updated
04/11/2022
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