Provider Demographics
NPI:1457663726
Name:KILGORE, LEIGHANNA (LICSW)
Entity Type:Individual
Prefix:MISS
First Name:LEIGHANNA
Middle Name:
Last Name:KILGORE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 NE 128TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7208
Mailing Address - Country:US
Mailing Address - Phone:425-821-8004
Mailing Address - Fax:
Practice Address - Street 1:11800 NE 128TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7208
Practice Address - Country:US
Practice Address - Phone:425-821-8004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.11001601041C0700X
WALW605900721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical