Provider Demographics
NPI:1427709872
Name:STOUDT, KILA MARIE
Entity type:Individual
Prefix:
First Name:KILA
Middle Name:MARIE
Last Name:STOUDT
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 1:10452 LODGE DR APT F14
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-7323
Mailing Address - Country:US
Mailing Address - Phone:517-231-1092
Mailing Address - Fax:
Practice Address - Street 1:10452 LODGE DR APT F14
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-7323
Practice Address - Country:US
Practice Address - Phone:517-231-1092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician