Provider Demographics
NPI:1649787813
Name:GERBER, KELLY I (RBT, CNA)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:I
Last Name:GERBER
Suffix:
Gender:F
Credentials:RBT, CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 WAIPUILANI CT
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-3476
Mailing Address - Country:US
Mailing Address - Phone:805-358-5818
Mailing Address - Fax:
Practice Address - Street 1:2118 WAIPUILANI CT
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-3476
Practice Address - Country:US
Practice Address - Phone:805-358-5818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician