Provider Demographics
NPI:1366014656
Name:MCCLELLAN, JADA AULIILANI
Entity Type:Individual
Prefix:
First Name:JADA
Middle Name:AULIILANI
Last Name:MCCLELLAN
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 1:94-392 NUI ST
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-2618
Mailing Address - Country:US
Mailing Address - Phone:808-354-4576
Mailing Address - Fax:
Practice Address - Street 1:203 KAPAA QUARRY PL
Practice Address - Street 2:#5002
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:808-247-2973
Practice Address - Fax:808-427-3472
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician