Individual
LACIE KILLIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
1700 AVENUE G, DODGE CITY, KS 67801-4544
(620) 255-8006
(620) 371-7304
Mailing address
1700 AVENUE G, DODGE CITY, KS 67801-4544
(620) 255-8006
(620) 371-7304
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
180788
KS
Other
Enumeration date
11/21/2016
Last updated
11/21/2016
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