Jacquelyn Jacky Blickenstaff, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

335 Issued in HI

Practice address

111 Hekili St Ste A406
Kailua, HI 96734-2800

Phone

(808) 489-3548

NPI assigned

Jan 16, 2018

Sex

Female

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Windward Synergy Center

  • Community/Behavioral Health Agency
  • Kailua, HI
  • NPI 1982078846
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 9, 2023.

{
    "created_epoch": "1516060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683590400000",
    "number": "1487162145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "619 PAOPUA LOOP",
            "city": "KAILUA",
            "state": "HI",
            "postal_code": "967343535",
            "telephone_number": "714-615-9697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 HEKILI ST STE A406",
            "city": "KAILUA",
            "state": "HI",
            "postal_code": "967342800",
            "telephone_number": "808-489-3548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLICKENSTAFF",
        "first_name": "JACQUELYN",
        "middle_name": "JACKY",
        "name_prefix": "Mrs.",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-16",
        "last_updated": "2023-05-09",
        "certification_date": "2023-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "1-19-38676",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "HI",
            "license": "335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Akemi Nakagawa Bischoff, L.AC.
• Jessica Bishop
• Brandee S Black, M.D.
• Margaret Irene Blaser, D.O.M.,L.AC., L.M.T.
• Jake Blechta, PHARMD
• Blue Therapy LLC
• Madeline Rose Boender, MSW
• Vanessa Catherine Bogert
• Princess Bohol
• Mia Boice

• All providers in Kailua, HI
• Behavior Analyst in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.