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NPI Code Detail

MEDICARE: JOYLYNN KILLGORE LMSW

MEDICARE:   JOYLYNN  KILLGORE  LMSW
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
11041C0700XClinical Social Worker6801081601MI

General Provider Information

NPI Number : 1851420855
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOYLYNN KILLGORE LMSW
Provider Business Mailing Address
First Line : 16350 CEDAR SPRINGS AVE
Second Line :
City : SAND LAKE
State : MI
Zip : 49343-9466
Country : US
Telephone Number : 616-696-2747
Fax Number :
Provider Business Practice Location Address
First Line : 1055 MEDICAL PARK DR SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-3607
Country : US
Telephone Number : 616-977-0794
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 07/17/2008

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Directions to “ JOYLYNN KILLGORE LMSW” Practice Location

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