Stacey Lynn Killeen, M.A, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146.006920 Issued in IL

Practice address

219 Primrose Dr
Dyer, IN 46311-4632

Phone

(219) 742-1400

Fax

(219) 809-2674

NPI assigned

Nov 9, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kor Speech Therapy, LLC

  • Speech-Language Pathologist
  • Dyer, IN
  • NPI 1518476639
  NPD (past) Authorized official
• Phoenix Children'S Hospital

  • Pediatrics Physician
  • Phoenix, AZ
  • NPI 1922112044
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412208000000",
    "number": "1841360690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 PRIMROSE DR",
            "city": "DYER",
            "state": "IN",
            "postal_code": "463114632",
            "telephone_number": "219-742-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 PRIMROSE DR",
            "city": "DYER",
            "state": "IN",
            "postal_code": "463114632",
            "telephone_number": "219-742-1400",
            "fax_number": "219-809-2674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KILLEEN",
        "first_name": "STACEY",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "M.A, CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-09",
        "last_updated": "2014-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146.006920",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IN",
            "license": "22005278A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anali Khalil
• Amena Khazaran
• Marco N. Khiella, MD
• Kidanu Birhanu MD SC
• Nathan Henry Kies, OTD
• Stephen K Kimani, LCSW
• Angela Klukken, OT
• Heather Kmiecik, FNP-BC
• Kor Speech Therapy, LLC
• Robert Kovachevich, DO

• Speech-Language Pathologist in Dyer, IN
• Providers in Dyer, IN by specialty
• Speech-Language Pathologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.