Provider Demographics
NPI:1043837883
Name:DILLON, JACEY RENEE
Entity Type:Individual
Prefix:
First Name:JACEY
Middle Name:RENEE
Last Name:DILLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2119 STONER DR W
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-3723
Mailing Address - Country:US
Mailing Address - Phone:217-549-6518
Mailing Address - Fax:
Practice Address - Street 1:2119 STONER DR W
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-3723
Practice Address - Country:US
Practice Address - Phone:217-549-6518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-27
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist