Healthcare Provider Details

I. General information

NPI: 1407491988
Provider Name (Legal Business Name): KRISTEN MARIE KILMER MS, CCC-SLP/TSSLD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2019
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 IDLEWILD AVE
CORNWALL ON HUDSON NY
12520-1134
US

IV. Provider business mailing address

4 HORSESHOE DR
POUGHKEEPSIE NY
12603-6308
US

V. Phone/Fax

Practice location:
  • Phone: 845-661-9778
  • Fax:
Mailing address:
  • Phone: 845-661-9778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number028901-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: