Provider Demographics
NPI:1063944015
Name:KILBOURNE, LINDA
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:KILBOURNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11832 NEWCASTLE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-8997
Mailing Address - Country:US
Mailing Address - Phone:225-456-2498
Mailing Address - Fax:225-810-3144
Practice Address - Street 1:11832 NEWCASTLE AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-8997
Practice Address - Country:US
Practice Address - Phone:225-456-2498
Practice Address - Fax:225-810-3144
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health