Individual
JACQUELYN MIKELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
75-5591 PALANI RD STE 204, KAILUA KONA, HI 96740-3632
(808) 345-6653
Mailing address
74-5050 HANAHANAI LOOP, KAILUA KONA, HI 96740-1537
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB851600
HI
Other
Enumeration date
03/20/2023
Last updated
03/20/2023
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