Provider Demographics
NPI:1871829465
Name:MAES, BRIANNA (SLP, BCBA)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:MAES
Suffix:
Gender:F
Credentials:SLP, BCBA
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:
Other - Last Name:TATEKAWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP, BCBA
Mailing Address - Street 1:94-1014 AHAHUI PL
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-2554
Mailing Address - Country:US
Mailing Address - Phone:808-499-5362
Mailing Address - Fax:808-379-2223
Practice Address - Street 1:70 S KAMEHAMEHA HWY STE 6
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-1856
Practice Address - Country:US
Practice Address - Phone:808-591-1173
Practice Address - Fax:808-591-1174
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIBA-81103K00000X
HISP-1016235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty