Individual
MRS. JACQUELYN JACKY BLICKENSTAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
111 HEKILI ST STE A406, KAILUA, HI 96734-2800
(808) 489-3548
Mailing address
619 PAOPUA LOOP, KAILUA, HI 96734-3535
(714) 615-9697
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
1-19-38676
CA
103K00000X
Behavior Analyst
Primary
335
HI
Other
Enumeration date
01/16/2018
Last updated
05/09/2023
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