Provider Demographics
NPI:1770623753
Name:BICKEL, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BICKEL
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 1:881 AKALEI PL
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3829
Mailing Address - Country:US
Mailing Address - Phone:808-780-9536
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 672 SCHOFIELD BARRACKS HEALTH CLINIC
Practice Address - Street 2:SELF CLINIC
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96857
Practice Address - Country:US
Practice Address - Phone:808-433-8814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1102103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical