Individual
AMY JACKSON JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED BT
Contact information
Practice address
427 ALA MAKANI ST STE 200, KAHULUI, HI 96732-3571
(808) 204-2893
Mailing address
427 ALA MAKANI ST STE 200, KAHULUI, HI 96732-3571
(808) 204-2893
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
RBT-23-253160
HI
106S00000X
Behavior Technician
RBT23-253160
HI
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/29/2023
Last updated
07/31/2024
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