Healthcare Provider Details

I. General information

NPI: 1366140253
Provider Name (Legal Business Name): JULIA CLAIRE WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 ULUNIU ST STE 103
KAILUA HI
96734-2541
US

IV. Provider business mailing address

1671 CITRON ST APT 2
HONOLULU HI
96826-2511
US

V. Phone/Fax

Practice location:
  • Phone: 808-489-3548
  • Fax:
Mailing address:
  • Phone: 973-287-9316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-25-16483
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: