Provider Demographics
NPI:1710383757
Name:KILCAWLEY, KEVIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:KILCAWLEY
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 1:2024 NW 92ND CT STE 12
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-5462
Mailing Address - Country:US
Mailing Address - Phone:515-421-8250
Mailing Address - Fax:
Practice Address - Street 1:2024 NW 92ND CT STE 12
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-5462
Practice Address - Country:US
Practice Address - Phone:515-421-8250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001356103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical