Provider Demographics
NPI:1558604017
Name:DILWORTH, JOHN FREDERICK (LLP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:FREDERICK
Last Name:DILWORTH
Suffix:
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:
Other - Last Name:HOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:313 S GULL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49083-9383
Mailing Address - Country:US
Mailing Address - Phone:269-254-6700
Mailing Address - Fax:
Practice Address - Street 1:491 COLUMBIA AVE E
Practice Address - Street 2:SUITE 4
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-5468
Practice Address - Country:US
Practice Address - Phone:269-962-9611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005958103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical