Provider Demographics
NPI:1417304619
Name:VIERRA, JODI ANNE SOUZA (BA)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:ANNE SOUZA
Last Name:VIERRA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:ANNE
Other - Last Name:SOUZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA
Mailing Address - Street 1:234 WAIANUENUE AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2418
Mailing Address - Country:US
Mailing Address - Phone:808-935-7949
Mailing Address - Fax:808-934-8318
Practice Address - Street 1:234 WAIANUENUE AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2418
Practice Address - Country:US
Practice Address - Phone:808-935-7949
Practice Address - Fax:808-934-8318
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker