Provider Demographics
NPI:1215434782
Name:KILPATRICK, REAGAN E (CDCA)
Entity type:Individual
Prefix:
First Name:REAGAN
Middle Name:E
Last Name:KILPATRICK
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 WARREN RD APT B
Mailing Address - Street 2:
Mailing Address - City:NEWTON FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44444-1184
Mailing Address - Country:US
Mailing Address - Phone:330-646-0165
Mailing Address - Fax:
Practice Address - Street 1:1023 WARREN RD APT B
Practice Address - Street 2:
Practice Address - City:NEWTON FALLS
Practice Address - State:OH
Practice Address - Zip Code:44444-1184
Practice Address - Country:US
Practice Address - Phone:330-646-0165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.187187101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)