Healthcare Provider Details

I. General information

NPI: 1629913355
Provider Name (Legal Business Name): KILGALLON SPEECH & LANGUAGE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3238 BOLGOS CIR
ANN ARBOR MI
48105-1589
US

IV. Provider business mailing address

3238 BOLGOS CIR
ANN ARBOR MI
48105-1589
US

V. Phone/Fax

Practice location:
  • Phone: 734-330-1088
  • Fax:
Mailing address:
  • Phone: 734-330-1088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KRISTOPHER DAVID KILGALLON
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: M.A., CCC-SLP/L
Phone: 734-330-1088