Provider Demographics
NPI:1194158279
Name:KAEO, JENNIFER L
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:KAEO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 KINOOLE ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3877
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:688 KINOOLE ST
Practice Address - Street 2:SUITE 120
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3877
Practice Address - Country:US
Practice Address - Phone:808-934-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor