Provider Demographics
NPI:1235728783
Name:DILLON, MARISSA KIMBERLY (SLPA)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:KIMBERLY
Last Name:DILLON
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 N 64TH ST UNIT 5
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-5608
Mailing Address - Country:US
Mailing Address - Phone:480-544-1214
Mailing Address - Fax:
Practice Address - Street 1:1111 N 64TH ST UNIT 5
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-5608
Practice Address - Country:US
Practice Address - Phone:480-544-1214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA127762355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant