Provider Demographics
NPI:1326178450
Name:DILLON, MICHELLE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:DILLON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N LITCHFIELD RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1333
Mailing Address - Country:US
Mailing Address - Phone:623-882-3980
Mailing Address - Fax:623-882-3980
Practice Address - Street 1:250 N LITCHFIELD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1333
Practice Address - Country:US
Practice Address - Phone:623-882-3980
Practice Address - Fax:623-882-3980
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP2161235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ815904Medicare ID - Type Unspecified