Individual
KEELY ANN DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
564 SOUTH ST, HONOLULU, HI 96813-5013
(804) 698-0490
Mailing address
3775 ANUHEA ST APT A, HONOLULU, HI 96816-3878
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-246187
HI
Other
Enumeration date
12/12/2022
Last updated
12/12/2022
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