Provider Demographics
NPI:1821349580
Name:KIESLOR, BRITTANY ANN
Entity Type:Individual
Prefix:MISS
First Name:BRITTANY
Middle Name:ANN
Last Name:KIESLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 S HIMES AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-5127
Mailing Address - Country:US
Mailing Address - Phone:732-691-9703
Mailing Address - Fax:
Practice Address - Street 1:6701 S HIMES AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-5127
Practice Address - Country:US
Practice Address - Phone:813-773-4849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJK42041006154905103K00000X
FLSW177581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst