MEDICARE: KATERI BARBARA KILLMAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	2463-C	AR

General Provider Information

NPI Number	:	1023317914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATERI BARBARA KILLMAN LCSW

Provider Business Mailing Address
First Line	:	17682 RIDGEWAY LN
Second Line	:
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761-5260
Country	:	US
Telephone Number	:	479-599-9385
Fax Number	:

Provider Business Practice Location Address
First Line	:	128 SOUTHWINDS RD STE 5
Second Line	:
City	:	FARMINGTON
State	:	AR
Zip	:	72730-8652
Country	:	US
Telephone Number	:	479-267-6934
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2011
Last Update Date	:	02/08/2024

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