Provider Demographics
NPI:1194337741
Name:UNDERWOOD, KRISTIANNA LYNN (BCBA)
Entity type:Individual
Prefix:
First Name:KRISTIANNA
Middle Name:LYNN
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KRISTIANNA
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:454 W PIPKIN RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2545
Mailing Address - Country:US
Mailing Address - Phone:863-619-2809
Mailing Address - Fax:
Practice Address - Street 1:454 W PIPKIN RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2545
Practice Address - Country:US
Practice Address - Phone:863-619-2809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician