Provider Demographics
NPI:1801104864
Name:GIBBONS, CHELSEA (AUD)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 KAPIOLANI BLVD
Mailing Address - Street 2:STE 6E
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3503
Mailing Address - Country:US
Mailing Address - Phone:808-955-4327
Mailing Address - Fax:808-589-2311
Practice Address - Street 1:1221 KAPIOLANI BLVD
Practice Address - Street 2:STE 6E
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3503
Practice Address - Country:US
Practice Address - Phone:808-955-4327
Practice Address - Fax:808-589-2311
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAUD-125231H00000X
HIHA-205237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist