Provider Demographics
NPI:1376375261
Name:KILBOURNE, ARIANA
Entity type:Individual
Prefix:
First Name:ARIANA
Middle Name:
Last Name:KILBOURNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3137 ELECTRIC AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-8110
Mailing Address - Country:US
Mailing Address - Phone:810-662-2626
Mailing Address - Fax:
Practice Address - Street 1:1159 S CARNEY DR
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079-5569
Practice Address - Country:US
Practice Address - Phone:810-662-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician