Individual
MS. STACEY LYNN KILLEEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A, CCC-SLP
Contact information
Practice address
219 PRIMROSE DR, DYER, IN 46311-4632
(219) 742-1400
(219) 809-2674
Mailing address
219 PRIMROSE DR, DYER, IN 46311-4632
(219) 742-1400
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146.006920
IL
235Z00000X
Speech-Language Pathologist
22005278A
IN
Other
Enumeration date
11/09/2006
Last updated
10/02/2014
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