Healthcare Provider Details

I. General information

NPI: 1962050450
Provider Name (Legal Business Name): MEAGHAN KILBOURN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 PLAZA DR
PETOSKEY MI
49770-9420
US

IV. Provider business mailing address

PO BOX 254
HARBOR SPRINGS MI
49740-0254
US

V. Phone/Fax

Practice location:
  • Phone: 231-347-7890
  • Fax:
Mailing address:
  • Phone: 989-335-1281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401001465
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: