Provider Demographics
NPI:1053865691
Name:SPENCER, KENNEDY RYAN (BCBA, MA, LBA)
Entity Type:Individual
Prefix:
First Name:KENNEDY
Middle Name:RYAN
Last Name:SPENCER
Suffix:
Gender:M
Credentials:BCBA, MA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 SOUTH ST APT 1808
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5925
Mailing Address - Country:US
Mailing Address - Phone:808-295-3305
Mailing Address - Fax:
Practice Address - Street 1:564 SOUTH ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5013
Practice Address - Country:US
Practice Address - Phone:808-591-1173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
HIBA-621103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician