Provider Demographics
NPI:1215940812
Name:CLEMENS, KRISTIN ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:ANN
Last Name:CLEMENS
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 1:8775 SIERRA COLLEGE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-5985
Mailing Address - Country:US
Mailing Address - Phone:916-382-7200
Mailing Address - Fax:916-382-8356
Practice Address - Street 1:8775 SIERRA COLLEGE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-5985
Practice Address - Country:US
Practice Address - Phone:916-382-7200
Practice Address - Fax:916-382-8356
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26469103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0031NNOtherBLUE CROSS BLUE SHIELD