Healthcare Provider Details

I. General information

NPI: 1548418601
Provider Name (Legal Business Name): JENNA ELAINE SYMONS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42-470 KALANIANAOLE HWY
KAILUA HI
96734-4373
US

IV. Provider business mailing address

42-470 KALANIANAOLE HWY
KAILUA HI
96734-4373
US

V. Phone/Fax

Practice location:
  • Phone: 808-266-9932
  • Fax:
Mailing address:
  • Phone: 808-266-9932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1345
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: