Provider Demographics
NPI:1043792849
Name:KILKER, MIKAELA
Entity Type:Individual
Prefix:
First Name:MIKAELA
Middle Name:
Last Name:KILKER
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:PO BOX 242
Mailing Address - Street 2:
Mailing Address - City:OLDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08858-0242
Mailing Address - Country:US
Mailing Address - Phone:908-439-3456
Mailing Address - Fax:908-439-2343
Practice Address - Street 1:152 OLDWICK RD
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE STATION
Practice Address - State:NJ
Practice Address - Zip Code:08889-5015
Practice Address - Country:US
Practice Address - Phone:908-439-3456
Practice Address - Fax:908-439-2343
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00590600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist