Provider Demographics
NPI:1992326508
Name:KILPATRICK, DESNIKKA
Entity type:Individual
Prefix:
First Name:DESNIKKA
Middle Name:
Last Name:KILPATRICK
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 1:80 BROOKHILL CT
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-6044
Mailing Address - Country:US
Mailing Address - Phone:813-452-7964
Mailing Address - Fax:
Practice Address - Street 1:8 EXECUTIVE DR STE 200
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-1350
Practice Address - Country:US
Practice Address - Phone:618-418-2201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor