Provider Demographics
NPI:1659968410
Name:OGUMA, PENNEY PUANANI (BA, CDCS,CSAC, ICADC)
Entity Type:Individual
Prefix:MS
First Name:PENNEY
Middle Name:PUANANI
Last Name:OGUMA
Suffix:
Gender:F
Credentials:BA, CDCS,CSAC, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 KATY JILL CT
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-5640
Mailing Address - Country:US
Mailing Address - Phone:808-673-9750
Mailing Address - Fax:
Practice Address - Street 1:1521 KATY JILL CT
Practice Address - Street 2:
Practice Address - City:NORTH POLE
Practice Address - State:AK
Practice Address - Zip Code:99705-5640
Practice Address - Country:US
Practice Address - Phone:808-673-9750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2022-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI101YA0400X
HI1880-15101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)