Provider Demographics
NPI:1023317914
Name:KILLMAN, KATERI BARBARA (LCSW)
Entity type:Individual
Prefix:
First Name:KATERI
Middle Name:BARBARA
Last Name:KILLMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17682 RIDGEWAY LN
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-5260
Mailing Address - Country:US
Mailing Address - Phone:479-599-9385
Mailing Address - Fax:
Practice Address - Street 1:128 SOUTHWINDS RD STE 5
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730-8652
Practice Address - Country:US
Practice Address - Phone:479-267-6934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2463-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical