Provider Demographics
NPI:1841763018
Name:IWASHITA, JEANNE MARIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:MARIE
Last Name:IWASHITA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:
Other - Last Name:IWASHITA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:94-665 KAAHOLO ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-1223
Mailing Address - Country:US
Mailing Address - Phone:800-675-0266
Mailing Address - Fax:808-675-0269
Practice Address - Street 1:94-665 KAAHOLO ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1223
Practice Address - Country:US
Practice Address - Phone:800-675-0266
Practice Address - Fax:808-675-0269
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HISP-813235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist