Provider Demographics
NPI:1417320052
Name:DILLON, NICHELLE (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:NICHELLE
Middle Name:
Last Name:DILLON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 LYNDALE AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3380
Mailing Address - Country:US
Mailing Address - Phone:800-336-5973
Mailing Address - Fax:612-234-4689
Practice Address - Street 1:5123 W 98TH ST STE 1072
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55437-2040
Practice Address - Country:US
Practice Address - Phone:612-263-7880
Practice Address - Fax:779-201-7798
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical