Provider Demographics
NPI:1851420855
Name:KILLGORE, JOYLYNN (LMSW)
Entity Type:Individual
Prefix:
First Name:JOYLYNN
Middle Name:
Last Name:KILLGORE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JOYLYNN
Other - Middle Name:
Other - Last Name:LOBBEZOO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:16350 CEDAR SPRINGS AVE
Mailing Address - Street 2:
Mailing Address - City:SAND LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49343-9466
Mailing Address - Country:US
Mailing Address - Phone:616-696-2747
Mailing Address - Fax:
Practice Address - Street 1:1055 MEDICAL PARK DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3607
Practice Address - Country:US
Practice Address - Phone:616-977-0794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010816011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical