Provider Demographics
NPI:1235891961
Name:KILBOURN, STEPHANIE MICHELLE
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:KILBOURN
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 1:2538 PEBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-7428
Mailing Address - Country:US
Mailing Address - Phone:214-226-3737
Mailing Address - Fax:
Practice Address - Street 1:1 DUVALL ST
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3210
Practice Address - Country:US
Practice Address - Phone:469-302-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105164235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist