Provider Demographics
NPI:1669195004
Name:KILGORE, SHERRON (MBA, ASAT,BSW)
Entity type:Individual
Prefix:
First Name:SHERRON
Middle Name:
Last Name:KILGORE
Suffix:
Gender:F
Credentials:MBA, ASAT,BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2127
Mailing Address - Country:US
Mailing Address - Phone:970-708-0853
Mailing Address - Fax:
Practice Address - Street 1:181 ELM AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2127
Practice Address - Country:US
Practice Address - Phone:970-708-0853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC0105362101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional