Healthcare Provider Details

I. General information

NPI: 1366369654
Provider Name (Legal Business Name): KRISTIN DANIELLE GILLIKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 CURE DR
MADISON NC
27025-1612
US

IV. Provider business mailing address

3301 HORSE PEN CREEK RD UNIT 1D
GREENSBORO NC
27410-9804
US

V. Phone/Fax

Practice location:
  • Phone: 336-548-2472
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number11950
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: