Individual
JEREMY KILLION
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1330 W AUTO DR, TEMPE, AZ 85284-1017
(480) 553-7153
Mailing address
1330 W AUTO DR, TEMPE, AZ 85284-1017
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
—
—
175T00000X
Peer Specialist
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841543345
—
AZ
Enumeration date
05/18/2022
Last updated
09/27/2022
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