Provider Demographics
NPI:1689426264
Name:KILGORE, NANCY ANNE (LMSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANNE
Last Name:KILGORE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8625 E BELLEVIEW PL UNIT 1017
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-4136
Mailing Address - Country:US
Mailing Address - Phone:623-565-4757
Mailing Address - Fax:
Practice Address - Street 1:831 GAIL GARDNER WAY
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1606
Practice Address - Country:US
Practice Address - Phone:623-565-4757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-191201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical