Provider Demographics
NPI:1104190107
Name:KILLINGER, SARAH JUANITA (MA, CCC SLP, BCBA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JUANITA
Last Name:KILLINGER
Suffix:
Gender:F
Credentials:MA, CCC SLP, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 LAURENCE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2978
Mailing Address - Country:US
Mailing Address - Phone:517-750-4777
Mailing Address - Fax:517-782-4717
Practice Address - Street 1:1001 LAURENCE AVE STE B
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2978
Practice Address - Country:US
Practice Address - Phone:517-750-4777
Practice Address - Fax:517-782-4717
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MI7401000828103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist