MEDICARE: DR. KARLENE KILMER PHD

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	103TC0700X	Clinical Psychologist	0890	NM
2	103TC0700X	Clinical Psychologist	3448	CO

General Provider Information

NPI Number	:	1063505048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARLENE KILMER PHD

Provider Business Mailing Address
First Line	:	441 MANITOU AVE STE 201
Second Line	:
City	:	MANITOU SPRINGS
State	:	CO
Zip	:	80829-2334
Country	:	US
Telephone Number	:	719-460-7289
Fax Number	:	719-623-0657

Provider Business Practice Location Address
First Line	:	441 MANITOU AVE STE 201
Second Line	:
City	:	MANITOU SPRINGS
State	:	CO
Zip	:	80829-2334
Country	:	US
Telephone Number	:	719-460-7289
Fax Number	:	719-623-0657

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	05/12/2016

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