Provider Demographics
NPI:1215473475
Name:KILLIAN, OLIVIA RAE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:RAE
Last Name:KILLIAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2881 CROWNE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-5357
Mailing Address - Country:US
Mailing Address - Phone:256-679-5195
Mailing Address - Fax:
Practice Address - Street 1:3140 CAHABA HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-5243
Practice Address - Country:US
Practice Address - Phone:205-969-8080
Practice Address - Fax:205-969-4884
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4045235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist