Provider Demographics
NPI:1942229620
Name:KILORAN, ANN MARILYN (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARILYN
Last Name:KILORAN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6458 AZALEA RD
Mailing Address - Street 2:
Mailing Address - City:MOTLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56466
Mailing Address - Country:US
Mailing Address - Phone:612-423-8862
Mailing Address - Fax:218-746-3809
Practice Address - Street 1:6458 AZALEA RD
Practice Address - Street 2:
Practice Address - City:MOTLEY
Practice Address - State:MN
Practice Address - Zip Code:56466-2106
Practice Address - Country:US
Practice Address - Phone:612-423-8862
Practice Address - Fax:218-746-3809
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN96431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical