Healthcare Provider Details

I. General information

NPI: 1851243737
Provider Name (Legal Business Name): KATHLEEN BERNICE KILCOIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33150 SCHOOLCRAFT RD STE L4
LIVONIA MI
48150-1631
US

IV. Provider business mailing address

PO BOX 595
WAYNE MI
48184-0595
US

V. Phone/Fax

Practice location:
  • Phone: 888-717-2102
  • Fax: 833-740-4255
Mailing address:
  • Phone: 888-717-2102
  • Fax: 833-740-4255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: