Provider Demographics
NPI:1578654992
Name:KILIAN, MARCUS K (PSYD)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:K
Last Name:KILIAN
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 1:1821 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE N385
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2801
Mailing Address - Country:US
Mailing Address - Phone:651-644-8515
Mailing Address - Fax:651-644-3451
Practice Address - Street 1:1821 UNIVERSITY AVE W
Practice Address - Street 2:SUITE N385
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2801
Practice Address - Country:US
Practice Address - Phone:651-644-8515
Practice Address - Fax:651-644-3451
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2610-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist