Provider Demographics
NPI:1144661828
Name:REYNOLDS, JEANNE (BCBA)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1256
Mailing Address - Street 2:
Mailing Address - City:HAIKU
Mailing Address - State:HI
Mailing Address - Zip Code:96708-1256
Mailing Address - Country:US
Mailing Address - Phone:808-268-8419
Mailing Address - Fax:
Practice Address - Street 1:2240 KOKOMO RD
Practice Address - Street 2:
Practice Address - City:HAIKU
Practice Address - State:HI
Practice Address - Zip Code:96708-7001
Practice Address - Country:US
Practice Address - Phone:808-268-8419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI6221225700000X
HIBA-842103K00000X
HIRBT-20-137412106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst