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General NPI Number Information
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NPI Number | 1053865691
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Entity Type | Individual
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Provider Name | KENNEDY RYAN SPENCER BCBA, MA, LBA
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Gender | Male
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Dates
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Enumeration Date | 08/11/2016
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Last Update Date | 12/30/2021
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Provider Practice Location Address
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Address Line | 564 SOUTH ST
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City | HONOLULU
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State | HI
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Zip | 96813-5013
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Country | US
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Telephone | 808-591-1173
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Fax |
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Provider Business Mailing Address
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Address Line | 801 SOUTH ST APT 1808
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City | HONOLULU
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State | HI
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Zip | 96813-5925
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Country | US
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Telephone | 808-295-3305
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BA-621
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License Number State | HI
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