Healthcare Provider Details

I. General information

NPI: 1295070167
Provider Name (Legal Business Name): JOAN HIFUMI WYLIE M.S./CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2012
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 N KUAKINI ST APT 2-I
HONOLULU HI
96817-2452
US

IV. Provider business mailing address

PO BOX 61999
HONOLULU HI
96839-1999
US

V. Phone/Fax

Practice location:
  • Phone: 808-282-0228
  • Fax:
Mailing address:
  • Phone: 808-282-0228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number956
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: