Provider Demographics
NPI:1073204269
Name:BJORK, KRISTEN ALECIA (PHD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ALECIA
Last Name:BJORK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2439 HASSONITE ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-7211
Mailing Address - Country:US
Mailing Address - Phone:352-281-7166
Mailing Address - Fax:
Practice Address - Street 1:2439 HASSONITE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-7211
Practice Address - Country:US
Practice Address - Phone:352-281-7166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1019800103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool