Provider Demographics
NPI:1689129199
Name:DILL, THERESA CAROL (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:CAROL
Last Name:DILL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65706-1212
Mailing Address - Country:US
Mailing Address - Phone:417-859-2120
Mailing Address - Fax:
Practice Address - Street 1:600 N LOCUST ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MO
Practice Address - Zip Code:65706-1212
Practice Address - Country:US
Practice Address - Phone:417-859-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016028046235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist