Provider Demographics
NPI:1164830766
Name:KILLION, SARAH BETH (LMP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:BETH
Last Name:KILLION
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 4TH AVE E
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4531
Mailing Address - Country:US
Mailing Address - Phone:503-302-2546
Mailing Address - Fax:360-943-0941
Practice Address - Street 1:805 W BAY DR NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4839
Practice Address - Country:US
Practice Address - Phone:360-943-7739
Practice Address - Fax:306-943-0941
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-27
Last Update Date:2014-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60468641174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist