Provider Demographics
NPI:1356472146
Name:DILLON, MOLLY JEAN (AUD)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:JEAN
Last Name:DILLON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SUGAR CREEK CTR
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714-3507
Mailing Address - Country:US
Mailing Address - Phone:479-876-0110
Mailing Address - Fax:479-876-0111
Practice Address - Street 1:22 SUGAR CREEK CTR
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72714-3507
Practice Address - Country:US
Practice Address - Phone:479-876-0110
Practice Address - Fax:479-876-0111
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR281231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist