MEDICARE: JOHN GAUNTT KILPATRICK MSW

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	101YS0200X	School Counselor	I-06049	NM
2	1041C0700X	Clinical Social Worker	LW60951098	WA

General Provider Information

NPI Number	:	1285961433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN GAUNTT KILPATRICK MSW

Provider Business Mailing Address
First Line	:	107 S DIVISION ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99202-1510
Country	:	US
Telephone Number	:	509-838-4651
Fax Number	:	509-363-2762

Provider Business Practice Location Address
First Line	:	711 E 3RD AVE
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99202-2211
Country	:	US
Telephone Number	:	509-838-4651
Fax Number	:	509-363-2762

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

Provider Enumeration Date	:	11/09/2009
Last Update Date	:	09/17/2019

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