Provider Demographics
NPI:1306027057
Name:KILPELA, GARY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:KILPELA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 WEST LAKE AVE.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931
Mailing Address - Country:US
Mailing Address - Phone:906-281-3459
Mailing Address - Fax:
Practice Address - Street 1:301 WEST LAKE AVE.
Practice Address - Street 2:SUITE 2
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931
Practice Address - Country:US
Practice Address - Phone:906-281-3459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013061103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent