Healthcare Provider Details

I. General information

NPI: 1720983901
Provider Name (Legal Business Name): CAITLYN MALIN PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST
HONOLULU HI
96826-1028
US

IV. Provider business mailing address

239 KAIULANI AVE APT 41
HONOLULU HI
96815-3018
US

V. Phone/Fax

Practice location:
  • Phone: 808-983-8230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSPP-101
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: