Individual
PENNIE KATHRYN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16-566 KEAAU PAHOA RD # 188-111, KEAAU, HI 96749-8137
(808) 294-3022
Mailing address
16-566 KEAAU PAHOA RD # 18-111, KEAAU, HI 96749-8137
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
-19-83292
HI
Other
Enumeration date
04/18/2019
Last updated
04/18/2019
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