Provider Demographics
NPI:1437360765
Name:IKEDA, JAMIE MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:MARIE
Last Name:IKEDA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 PUNAHOU ST
Mailing Address - Street 2:BINGHAM BLDG SUITE 2015
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1001
Mailing Address - Country:US
Mailing Address - Phone:808-983-8230
Mailing Address - Fax:808-983-6752
Practice Address - Street 1:1319 PUNAHOU ST
Practice Address - Street 2:BINGHAM BLDG SUITE 2015
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1001
Practice Address - Country:US
Practice Address - Phone:808-983-8230
Practice Address - Fax:808-983-6752
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HISP-782235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist