Provider Demographics
NPI:1548038011
Name:KILGORE, RILEIGH (LSW)
Entity type:Individual
Prefix:
First Name:RILEIGH
Middle Name:
Last Name:KILGORE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 E FAIRLAWN DR
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-5146
Mailing Address - Country:US
Mailing Address - Phone:217-480-7068
Mailing Address - Fax:
Practice Address - Street 1:2104 WINDSOR PL STE A
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7773
Practice Address - Country:US
Practice Address - Phone:217-552-1058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.109709104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker