Healthcare Provider Details

I. General information

NPI: 1144654542
Provider Name (Legal Business Name): TRACY KILLIAN M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1958 ELM ST
DENVER CO
80220-1247
US

IV. Provider business mailing address

901 COLORADO BLVD APT 621
DENVER CO
80206-4086
US

V. Phone/Fax

Practice location:
  • Phone: 303-333-4982
  • Fax:
Mailing address:
  • Phone: 720-331-7267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0001442
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: