Healthcare Provider Details

I. General information

NPI: 1356428759
Provider Name (Legal Business Name): KRISTINE NOEL PHD, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 ALA MOANA BLVD STE 625
HONOLULU HI
96813
US

IV. Provider business mailing address

677 ALA MOANA BLVD STE 1001
HONOLULU HI
96813-5408
US

V. Phone/Fax

Practice location:
  • Phone: 808-692-1580
  • Fax: 808-566-6292
Mailing address:
  • Phone: 808-469-4900
  • Fax: 808-587-9507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1797
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-1398
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: