Provider Demographics
NPI:1447082870
Name:IGE, JANELLE MISTY
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:MISTY
Last Name:IGE
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 1:91-1362 KAKIWI ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-5845
Mailing Address - Country:US
Mailing Address - Phone:808-312-7268
Mailing Address - Fax:
Practice Address - Street 1:91-1362 KAKIWI ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-5845
Practice Address - Country:US
Practice Address - Phone:808-312-7268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI51951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical