Individual
JENNIFER AGBEBIYI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4510 SALT LAKE BLVD, HONOLULU, HI 96818
(808) 456-4810
Mailing address
4510 SALT LAKE BLVD, HONOLULU, HI 96818-3153
(808) 486-1804
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
1615727
HI
Other
Enumeration date
12/22/2017
Last updated
05/31/2018
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