Provider Demographics
NPI:1255110714
Name:VOELKEL, KELLY S
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:S
Last Name:VOELKEL
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 1:1049 MOKAPU BLVD
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1843
Mailing Address - Country:US
Mailing Address - Phone:850-819-5422
Mailing Address - Fax:
Practice Address - Street 1:1049 MOKAPU BLVD
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1843
Practice Address - Country:US
Practice Address - Phone:850-819-5422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician