Healthcare Provider Details

I. General information

NPI: 1023796414
Provider Name (Legal Business Name): KRISTIN SCOTT CLEMENTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 W BEACON RD
LAKELAND FL
33803-2847
US

IV. Provider business mailing address

3961 COUNTY ROAD 557A
POLK CITY FL
33868-9210
US

V. Phone/Fax

Practice location:
  • Phone: 863-220-1205
  • Fax:
Mailing address:
  • Phone: 863-797-6999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: