Healthcare Provider Details

I. General information

NPI: 1063505048
Provider Name (Legal Business Name): KARLENE KILMER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 MANITOU AVE STE 201
MANITOU SPRINGS CO
80829-2334
US

IV. Provider business mailing address

441 MANITOU AVE STE 201
MANITOU SPRINGS CO
80829-2334
US

V. Phone/Fax

Practice location:
  • Phone: 719-460-7289
  • Fax: 719-623-0657
Mailing address:
  • Phone: 719-460-7289
  • Fax: 719-623-0657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0890
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3448
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: