Provider Demographics
NPI:1003401852
Name:WEBB, JEREMIAH HUDSON
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:HUDSON
Last Name:WEBB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 ALA MAKANI ST STE 100
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-3507
Mailing Address - Country:US
Mailing Address - Phone:808-446-9024
Mailing Address - Fax:
Practice Address - Street 1:427 ALA MAKANI ST STE 100
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-3507
Practice Address - Country:US
Practice Address - Phone:808-446-9024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician