Provider Demographics
NPI:1598051294
Name:KILLIAN, SPENCE DEE
Entity Type:Individual
Prefix:MR
First Name:SPENCE
Middle Name:DEE
Last Name:KILLIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 EASTGATE NORTH
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362
Mailing Address - Country:US
Mailing Address - Phone:509-529-2693
Mailing Address - Fax:509-529-9469
Practice Address - Street 1:2330 EASTGATE NORTH
Practice Address - Street 2:SUITE 101
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362
Practice Address - Country:US
Practice Address - Phone:509-529-2693
Practice Address - Fax:509-529-9469
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA 00002210174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist