Provider Demographics
NPI:1720959844
Name:PEDERSEN, JENSINE FAITH
Entity type:Individual
Prefix:
First Name:JENSINE
Middle Name:FAITH
Last Name:PEDERSEN
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 1:221 APUWAI ST
Mailing Address - Street 2:
Mailing Address - City:HAIKU
Mailing Address - State:HI
Mailing Address - Zip Code:96708-4811
Mailing Address - Country:US
Mailing Address - Phone:808-359-4762
Mailing Address - Fax:
Practice Address - Street 1:221 APUWAI ST
Practice Address - Street 2:
Practice Address - City:HAIKU
Practice Address - State:HI
Practice Address - Zip Code:96708-4811
Practice Address - Country:US
Practice Address - Phone:808-359-4762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-25-471948106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician