Provider Demographics
NPI:1952965410
Name:KILLIAN, SARAH BETH (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:BETH
Last Name:KILLIAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:BETH
Other - Last Name:DERIEMACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CF-SLP
Mailing Address - Street 1:851 PROFESSIONAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040
Mailing Address - Country:US
Mailing Address - Phone:931-542-2168
Mailing Address - Fax:
Practice Address - Street 1:851 PROFESSIONAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040
Practice Address - Country:US
Practice Address - Phone:931-542-2168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
TN6415235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist