Provider Demographics
NPI:1417416991
Name:JARDINE, KALANIKAULELEIAIWI AH LEN (RBT)
Entity Type:Individual
Prefix:
First Name:KALANIKAULELEIAIWI
Middle Name:AH LEN
Last Name:JARDINE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:KALANIKAULELEIAIWI
Other - Middle Name:AH LEN
Other - Last Name:KAAUWAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:316 MID VALLEY CTR # 186
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-8516
Mailing Address - Country:US
Mailing Address - Phone:808-431-4655
Mailing Address - Fax:
Practice Address - Street 1:4359 KUKUI GROVE ST STE 102
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-2008
Practice Address - Country:US
Practice Address - Phone:808-431-4655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2020-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-19-80074106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician