Provider Demographics
NPI:1548418601
Name:SYMONS, JENNA ELAINE (PSYD)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:ELAINE
Last Name:SYMONS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42-470 KALANIANAOLE HWY
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4373
Mailing Address - Country:US
Mailing Address - Phone:808-266-9932
Mailing Address - Fax:
Practice Address - Street 1:42-470 KALANIANAOLE HWY
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4373
Practice Address - Country:US
Practice Address - Phone:808-266-9932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1345103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent