Provider Demographics
NPI:1245858257
Name:CLEM, KAITLIN ELIZABETH (MA, BCBA)
Entity type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:ELIZABETH
Last Name:CLEM
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5925 SACRO MONTE DR # 1116
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-4706
Mailing Address - Country:US
Mailing Address - Phone:845-549-5660
Mailing Address - Fax:
Practice Address - Street 1:161 JD TOWLES DR
Practice Address - Street 2:
Practice Address - City:WILLOW PARK
Practice Address - State:TX
Practice Address - Zip Code:76087-8654
Practice Address - Country:US
Practice Address - Phone:682-900-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst