Healthcare Provider Details

I. General information

NPI: 1073892808
Provider Name (Legal Business Name): CHAD KILLPACK PSY.D., ABPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CHAD KILLPACK PSY.D.

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 07/23/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 HCOS/SGGK EPIC FLIGHT
APO NY
09012
US

IV. Provider business mailing address

86 MDOS FLUGPLATZ RAMSTEIN GEB 2114
APO AE
09012
US

V. Phone/Fax

Practice location:
  • Phone: 314-479-2469
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY 60340649
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: