Provider Demographics
NPI:1245315373
Name:KILPATRICK, DIANE C (PHD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:C
Last Name:KILPATRICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 696
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070-0696
Mailing Address - Country:US
Mailing Address - Phone:985-785-8200
Mailing Address - Fax:985-785-3779
Practice Address - Street 1:1057 PAUL MAILLARD RD
Practice Address - Street 2:SUITE 210
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-4349
Practice Address - Country:US
Practice Address - Phone:985-785-8200
Practice Address - Fax:985-785-3779
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA551103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2144EOtherBLUE CROSS BLUE SHIELD