Provider Demographics
NPI:1609062900
Name:KILGOUR, JORDAN M JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:M
Last Name:KILGOUR
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6718 PATTERSON AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3419
Mailing Address - Country:US
Mailing Address - Phone:804-282-5644
Mailing Address - Fax:804-285-0006
Practice Address - Street 1:6718 PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3419
Practice Address - Country:US
Practice Address - Phone:804-282-5644
Practice Address - Fax:804-285-0006
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003644103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical