Individual
AMMON RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
94-450 MOKUOLA ST STE 100, WAIPAHU, HI 96797-3388
(808) 944-2882
Mailing address
4157 KAWILI ST, LIHUE, HI 96766-1449
(385) 252-9551
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
RBT-22-217902
UT
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/31/2022
Last updated
05/10/2026
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