Provider Demographics
NPI:1396826202
Name:DETWILER, JAMIE A (LSW, MSW)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:A
Last Name:DETWILER
Suffix:
Gender:F
Credentials:LSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-1035 HOOKANAHE ST
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-4201
Mailing Address - Country:US
Mailing Address - Phone:808-222-1750
Mailing Address - Fax:808-433-0381
Practice Address - Street 1:459 PATTERSON RD
Practice Address - Street 2:VAPIHCS
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1522
Practice Address - Country:US
Practice Address - Phone:808-433-0512
Practice Address - Fax:808-433-0381
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI951104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
HILSW-951OtherLICENSED SOCIAL WORKER