Provider Demographics
NPI:1528532439
Name:STEPHENS, KATHLEEN ANNE
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANNE
Last Name:STEPHENS
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 1:7710 KINGS PASSAGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5953
Mailing Address - Country:US
Mailing Address - Phone:954-298-3248
Mailing Address - Fax:
Practice Address - Street 1:7710 KINGS PASSAGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5953
Practice Address - Country:US
Practice Address - Phone:954-298-3248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician