Provider Demographics
NPI:1003979477
Name:JAGEL, JADU MALCOLM (PSYD)
Entity Type:Individual
Prefix:
First Name:JADU
Middle Name:MALCOLM
Last Name:JAGEL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47-506 HIO PL
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-4840
Mailing Address - Country:US
Mailing Address - Phone:415-846-2511
Mailing Address - Fax:
Practice Address - Street 1:47-506 HIO PL
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-4840
Practice Address - Country:US
Practice Address - Phone:415-846-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TF0000X
HIPSY-2088-0103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily