MEDICARE: TRACY KILLIAN M.S. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	0001442	CO

General Provider Information

NPI Number	:	1144654542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY KILLIAN M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	901 COLORADO BLVD
Second Line	:	APT 621
City	:	DENVER
State	:	CO
Zip	:	80206-4086
Country	:	US
Telephone Number	:	720-331-7267
Fax Number	:

Provider Business Practice Location Address
First Line	:	1958 ELM ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-1247
Country	:	US
Telephone Number	:	303-333-4982
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2013
Last Update Date	:	08/21/2013

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