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General NPI Number Information
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NPI Number | 1598431116
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Entity Type | Individual
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Provider Name | GRACE LILLIAN KILGORE LGSW
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Gender | Female
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Dates
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Enumeration Date | 08/23/2021
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 8550 HUDSON BLVD N
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City | LAKE ELMO
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State | MN
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Zip | 55042-5500
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Country | US
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Telephone | 651-254-8580
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Fax |
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Provider Business Mailing Address
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Address Line | 84 WATER ST W APT 604
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City | SAINT PAUL
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State | MN
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Zip | 55107-2009
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Country | US
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Telephone | 651-210-4249
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 29780
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License Number State | MN
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