Provider Demographics
NPI:1033324124
Name:KILLIAN, MARY L (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:L
Last Name:KILLIAN
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 HIGHWAY 65 S
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-4747
Mailing Address - Country:US
Mailing Address - Phone:870-421-8945
Mailing Address - Fax:
Practice Address - Street 1:2150 HIGHWAY 65 S
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-4747
Practice Address - Country:US
Practice Address - Phone:870-421-8945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSLP# 1155235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist