Provider Demographics
NPI:1801390562
Name:STRELOW, JESSE SCOTT
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:SCOTT
Last Name:STRELOW
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 1:1330 ALA MOANA BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4262
Mailing Address - Country:US
Mailing Address - Phone:808-380-4465
Mailing Address - Fax:
Practice Address - Street 1:1515 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-2597
Practice Address - Country:US
Practice Address - Phone:655-808-6550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty