Provider Demographics
NPI:1811019193
Name:DILLON, DEBORAH (SLP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:DILLON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10435 N COUNTY ROAD 471 E
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:IN
Mailing Address - Zip Code:46167-9407
Mailing Address - Country:US
Mailing Address - Phone:312-892-8084
Mailing Address - Fax:317-892-8084
Practice Address - Street 1:10435 N COUNTY ROAD 471 E
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:IN
Practice Address - Zip Code:46167-9407
Practice Address - Country:US
Practice Address - Phone:312-892-8084
Practice Address - Fax:317-892-8084
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22000996A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200609870Medicaid
IN200708700Medicaid