Provider Demographics
NPI:1295070167
Name:WYLIE, JOAN HIFUMI (MS/CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:HIFUMI
Last Name:WYLIE
Suffix:
Gender:F
Credentials:MS/CCC-SLP
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 61999
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96839-1999
Mailing Address - Country:US
Mailing Address - Phone:808-282-0228
Mailing Address - Fax:
Practice Address - Street 1:60 N KUAKINI ST
Practice Address - Street 2:APT 2-I
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2452
Practice Address - Country:US
Practice Address - Phone:808-282-0228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI956235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist