Healthcare Provider Details

I. General information

NPI: 1396190120
Provider Name (Legal Business Name): ASHLEY LEVAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MILESTONES CENTER FOR PEDIATRIC NEURODEVELOPMENT 820 MILILANI ST. SUITE 400
HONOLULU HI
96813
US

IV. Provider business mailing address

7183 KOAMANO ST
HONOLULU HI
96825-2408
US

V. Phone/Fax

Practice location:
  • Phone: 808-979-6700
  • Fax: 808-441-9875
Mailing address:
  • Phone: 217-341-9704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY-1740
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: