Provider Demographics
NPI:1851316509
Name:KILDOW, GLORIA JEAN (MA, LLP, LLP)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:JEAN
Last Name:KILDOW
Suffix:
Gender:F
Credentials:MA, LLP, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6770 DIXIE HWY.
Mailing Address - Street 2:SUITE 312
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346
Mailing Address - Country:US
Mailing Address - Phone:248-922-2300
Mailing Address - Fax:248-922-2304
Practice Address - Street 1:6770 DIXIE HWY
Practice Address - Street 2:SUITE 312
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2087
Practice Address - Country:US
Practice Address - Phone:248-922-2300
Practice Address - Fax:248-922-2304
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005666101YM0800X
MI6301009407103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling