Provider Demographics
NPI:1144654542
Name:KILLIAN, TRACY (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:KILLIAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 COLORADO BLVD
Mailing Address - Street 2:APT 621
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-4086
Mailing Address - Country:US
Mailing Address - Phone:720-331-7267
Mailing Address - Fax:
Practice Address - Street 1:1958 ELM ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-1247
Practice Address - Country:US
Practice Address - Phone:303-333-4982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001442235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist