Individual
JORDAN GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
1001 KAMOKILA BLVD STE 133, KAPOLEI, HI 96707-2097
(808) 800-1195
Mailing address
1001 KAMOKILA BLVD STE 133, KAPOLEI, HI 96707-2097
(808) 800-1195
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BA-301
HI
106S00000X
Behavior Technician
RBT-16-25760
HI
Other
Enumeration date
11/16/2016
Last updated
07/17/2019
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