Provider Demographics
NPI:1205538170
Name:REAVELEY, EMILY VICTORIA KALEINANI
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:VICTORIA KALEINANI
Last Name:REAVELEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1199 KANEANA ST APT G
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-4732
Mailing Address - Country:US
Mailing Address - Phone:801-706-3663
Mailing Address - Fax:
Practice Address - Street 1:725 KAPIOLANI BLVD STE C206
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-6024
Practice Address - Country:US
Practice Address - Phone:808-596-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HISP-2215-0235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist