Provider Demographics
NPI:1629251574
Name:CLEMENTS, KRISTI M (LISW)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:M
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 W DALE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-1901
Mailing Address - Country:US
Mailing Address - Phone:319-233-3351
Mailing Address - Fax:319-233-3132
Practice Address - Street 1:146 W DALE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1901
Practice Address - Country:US
Practice Address - Phone:319-233-3351
Practice Address - Fax:319-233-3132
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA006919104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker