Healthcare Provider Details

I. General information

NPI: 1932028487
Provider Name (Legal Business Name): ALISON KILCUP MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15110 BOONES FERRY RD STE 300H
LAKE OSWEGO OR
97035-3460
US

IV. Provider business mailing address

15110 BOONES FERRY RD STE 300H
LAKE OSWEGO OR
97035-3460
US

V. Phone/Fax

Practice location:
  • Phone: 541-703-3210
  • Fax:
Mailing address:
  • Phone: 541-703-3210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ALISON KILCUP
Title or Position: OWNER
Credential: MD
Phone: 310-280-8394