Provider Demographics
NPI:1588257810
Name:EVANS, JESSICA RACHEL (RBT)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:RACHEL
Last Name:EVANS
Suffix:
Gender:F
Credentials:RBT
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Mailing Address - Street 1:607 N KING ST # A124
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-5714
Mailing Address - Country:US
Mailing Address - Phone:206-451-3671
Mailing Address - Fax:
Practice Address - Street 1:94-450 MOKUOLA ST STE 100
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3388
Practice Address - Country:US
Practice Address - Phone:808-942-2882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIRBT-20-113297106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician