Individual
ELYSIA MAE CLEARENCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
92-1126 OLANI ST APT 1, KAPOLEI, HI 96707-4227
(714) 210-9411
Mailing address
92-1126 OLANI ST APT 1, KAPOLEI, HI 96707-4227
(714) 210-9411
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB386532
HI
Other
Enumeration date
12/29/2017
Last updated
12/29/2017
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