Provider Demographics
NPI:1841892882
Name:JONES, JESSICA GRANDINETTI
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:GRANDINETTI
Last Name:JONES
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 1:6490 KIPAPA RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-8617
Mailing Address - Country:US
Mailing Address - Phone:209-814-4456
Mailing Address - Fax:
Practice Address - Street 1:4359 KUKUI GROVE ST STE 102
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-2008
Practice Address - Country:US
Practice Address - Phone:808-431-4655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician