MEDICARE: CHRISTINE KILIAN

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	235Z00000X	Speech-Language Pathologist	29388	CA

General Provider Information

NPI Number	:	1215675053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE KILIAN

Provider Business Mailing Address
First Line	:	2115 W PINE ST
Second Line	:
City	:	LODI
State	:	CA
Zip	:	95242-2858
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 WAGNER HEIGHTS RD
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95209-4843
Country	:	US
Telephone Number	:	209-956-3400
Fax Number	:

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

Provider Enumeration Date	:	05/23/2022
Last Update Date	:	05/23/2022

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Directions to “ CHRISTINE KILIAN ” Practice Location

Language	Start Address	Practice Location

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