Healthcare Provider Details

I. General information

NPI: 1073204269
Provider Name (Legal Business Name): KRISTEN ALECIA BJORK PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2439 HASSONITE ST
KISSIMMEE FL
34744-7211
US

IV. Provider business mailing address

2439 HASSONITE ST
KISSIMMEE FL
34744-7211
US

V. Phone/Fax

Practice location:
  • Phone: 352-281-7166
  • Fax:
Mailing address:
  • Phone: 352-281-7166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1019800
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: