Provider Demographics
NPI:1215510151
Name:GILMORE, KATELYN NICOLE (MA)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:NICOLE
Last Name:GILMORE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8063 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-6001
Mailing Address - Country:US
Mailing Address - Phone:845-826-3721
Mailing Address - Fax:
Practice Address - Street 1:8063 MADISON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-6001
Practice Address - Country:US
Practice Address - Phone:845-826-3721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
INRBT-22-205955106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician