Provider Demographics
NPI:1679610067
Name:KILROW, LISA BAILEY
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:BAILEY
Last Name:KILROW
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:BAILEY
Other - Last Name:KILROW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:1776 S JACKSON ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3801
Mailing Address - Country:US
Mailing Address - Phone:303-757-2385
Mailing Address - Fax:
Practice Address - Street 1:1776 S JACKSON ST
Practice Address - Street 2:SUITE 405
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3801
Practice Address - Country:US
Practice Address - Phone:303-757-2385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO989104101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11238553OtherCAQH PROVIDER ID
CO214487OtherVALUE OPTIONS PROVIDER
CO989104OtherSTATE LICENSE