Provider Demographics
NPI:1609506641
Name:JASLOW, JODI KIMBERLY (MA)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:KIMBERLY
Last Name:JASLOW
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:KIMBERLY
Other - Last Name:JAFFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:270 WAIEHU BEACH RD STE 213
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1472
Mailing Address - Country:US
Mailing Address - Phone:808-243-1263
Mailing Address - Fax:
Practice Address - Street 1:270 WAIEHU BEACH RD STE 213
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1472
Practice Address - Country:US
Practice Address - Phone:808-243-1263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty