Provider Demographics
NPI:1508635475
Name:ELAZIER, JAYDA NICOLE
Entity Type:Individual
Prefix:
First Name:JAYDA
Middle Name:NICOLE
Last Name:ELAZIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1684 SAINT LOUIS DR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-1923
Mailing Address - Country:US
Mailing Address - Phone:347-567-2248
Mailing Address - Fax:
Practice Address - Street 1:1448 LILIHA ST STE 201
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3589
Practice Address - Country:US
Practice Address - Phone:808-681-2718
Practice Address - Fax:855-975-2866
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-23-317616106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician