Provider Demographics
NPI:1477718336
Name:KILGORE, JACLYN POPILLO (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:POPILLO
Last Name:KILGORE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CAROLINA MDWS
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-8471
Mailing Address - Country:US
Mailing Address - Phone:919-932-4643
Mailing Address - Fax:
Practice Address - Street 1:500 CAROLINA MDWS
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-8471
Practice Address - Country:US
Practice Address - Phone:919-932-4643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCTEMPORARY LICENSE235Z00000X
NC8434235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist