MEDICARE: CLINICAL PSYCHOLOGY SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1437624756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICAL PSYCHOLOGY SERVICES, LLC

Provider Business Mailing Address
First Line	:	94-229 WAIPAHU DEPOT ST STE 400
Second Line	:
City	:	WAIPAHU
State	:	HI
Zip	:	96797-3034
Country	:	US
Telephone Number	:	808-294-0495
Fax Number	:

Provider Business Practice Location Address
First Line	:	91-3575 KAULUAKOKO ST
Second Line	:	1108
City	:	EWA BEACH
State	:	HI
Zip	:	96706-5856
Country	:	US
Telephone Number	:	808-294-0495
Fax Number	:	808-439-6869

Authorized Official
Title or Position	:	PSYCHOLOGIST / OWNER
Name	:	DR. SHAWNA LYNN LEDWARD
Credential	:	PSYD
Telephone Number	:	808-294-0495

Provider Enumeration Date	:	10/13/2018
Last Update Date	:	04/26/2024

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