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General NPI Number Information
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NPI Number | 1770765794
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Entity Type | Organization
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Legal Business Name | KATHERINE M KILGORE PHD INC
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Dates
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Enumeration Date | 11/30/2007
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Last Update Date | 11/18/2021
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Provider Practice Location Address
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Address Line | 13405 FOLSOM BLVD SUITE 220
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City | FOLSOM
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State | CA
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Zip | 95630-4738
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Country | US
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Telephone | 916-357-5999
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Fax |
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Provider Business Mailing Address
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Address Line | 13405 FOLSOM BLVD SUITE 220
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City | FOLSOM
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State | CA
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Zip | 95630-4738
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Country | US
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Telephone | 916-357-5999
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHERINE KILGORE
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Credential | PHD
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Telephone | 916-458-5505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 14094
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License Number State | CA
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