Provider Demographics
NPI:1598357881
Name:KOMETANI, MARCI MAY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:MAY
Last Name:KOMETANI
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:766 WILIWILI ST APT C
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-4127
Mailing Address - Country:US
Mailing Address - Phone:808-772-9321
Mailing Address - Fax:
Practice Address - Street 1:3155 MANOA RD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-1228
Practice Address - Country:US
Practice Address - Phone:808-988-1868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1886235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist