Provider Demographics
NPI:1669857785
Name:DENNIS, MICHELLE ANGELA
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANGELA
Last Name:DENNIS
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:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:HANALEI
Mailing Address - State:HI
Mailing Address - Zip Code:96714-0263
Mailing Address - Country:US
Mailing Address - Phone:352-552-4817
Mailing Address - Fax:
Practice Address - Street 1:3-3122 KUHIO HWY
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1147
Practice Address - Country:US
Practice Address - Phone:808-246-9102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst