Provider Demographics
NPI:1598485518
Name:KENDRICK, OWEN ABRAHAM
Entity Type:Individual
Prefix:
First Name:OWEN
Middle Name:ABRAHAM
Last Name:KENDRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 ANAPUNI ST APT 305
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-4417
Mailing Address - Country:US
Mailing Address - Phone:919-740-4663
Mailing Address - Fax:
Practice Address - Street 1:98-820 MOANALUA RD
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5200
Practice Address - Country:US
Practice Address - Phone:808-845-6080
Practice Address - Fax:808-845-6081
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
HI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician