Provider Demographics
NPI:1467711192
Name:KANEKOA, JACQUELINE (MSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:KANEKOA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 HANAKAI ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-3414
Mailing Address - Country:US
Mailing Address - Phone:888-227-5756
Mailing Address - Fax:808-873-9696
Practice Address - Street 1:349 HANAKAI ST
Practice Address - Street 2:SUITE C
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-3414
Practice Address - Country:US
Practice Address - Phone:888-227-5756
Practice Address - Fax:808-873-9696
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator