Provider Demographics
NPI:1770765794
Name:KATHERINE M KILGORE PHD INC
Entity type:Organization
Organization Name:KATHERINE M KILGORE PHD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:916-458-5505
Mailing Address - Street 1:13405 FOLSOM BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-4738
Mailing Address - Country:US
Mailing Address - Phone:916-357-5999
Mailing Address - Fax:
Practice Address - Street 1:13405 FOLSOM BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4738
Practice Address - Country:US
Practice Address - Phone:916-357-5999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14094103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ26160ZMedicare PIN