MEDICARE: JESSICA ANN MCGLAUGHLIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	BA-463	HI

General Provider Information

NPI Number	:	1194187120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ANN MCGLAUGHLIN

Provider Business Mailing Address
First Line	:	2127B KELIKOLI ST
Second Line	:
City	:	LIHUE
State	:	HI
Zip	:	96766-8956
Country	:	US
Telephone Number	:	808-443-4317
Fax Number	:

Provider Business Practice Location Address
First Line	:	3175 ELUA ST STE B
Second Line	:
City	:	LIHUE
State	:	HI
Zip	:	96766-1203
Country	:	US
Telephone Number	:	808-246-4808
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2016
Last Update Date	:	02/03/2021

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Directions to “ JESSICA ANN MCGLAUGHLIN ” Practice Location

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