Provider Demographics
NPI:1053546085
Name:RICE, JIZELLE VICENTA MALIA YATES (MSLTPRAC (SLP) CCC-S)
Entity type:Individual
Prefix:MRS
First Name:JIZELLE
Middle Name:VICENTA MALIA YATES
Last Name:RICE
Suffix:
Gender:F
Credentials:MSLTPRAC (SLP) CCC-S
Other - Prefix:
Other - First Name:JIZELLE
Other - Middle Name:VM
Other - Last Name:YATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 928
Mailing Address - Street 2:
Mailing Address - City:CAPTAIN COOK
Mailing Address - State:HI
Mailing Address - Zip Code:96704
Mailing Address - Country:US
Mailing Address - Phone:808-987-2451
Mailing Address - Fax:855-746-1544
Practice Address - Street 1:81-6587 MAMALAHOA HWY.
Practice Address - Street 2:SUITE C-203
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750
Practice Address - Country:US
Practice Address - Phone:808-987-2451
Practice Address - Fax:855-746-1544
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
HI235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor