Provider Demographics
NPI:1215037031
Name:DILLON, MELANIE ELISE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:ELISE
Last Name:DILLON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 BURNETT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-8670
Mailing Address - Country:US
Mailing Address - Phone:847-393-5646
Mailing Address - Fax:
Practice Address - Street 1:697 S LAKE ST
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-3658
Practice Address - Country:US
Practice Address - Phone:847-406-0789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2016-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-000335101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1538567870OtherNPPES
IL1215037031OtherNPPES