Provider Demographics
NPI:1275822397
Name:DILLON, NICHOLAS (MS, MA, SACIT)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
Last Name:DILLON
Suffix:
Gender:M
Credentials:MS, MA, SACIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3815 N BROOKFIELD RD
Mailing Address - Street 2:SUITE 104-141
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-1964
Mailing Address - Country:US
Mailing Address - Phone:866-305-9818
Mailing Address - Fax:262-691-4966
Practice Address - Street 1:1177 QUAIL CT
Practice Address - Street 2:SUITE 203
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-3790
Practice Address - Country:US
Practice Address - Phone:262-691-2980
Practice Address - Fax:262-691-4966
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16137-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)