Provider Demographics
NPI:1821132770
Name:DILLEY, JACQUELINE (MSW)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:DILLEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 PITTSFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-5242
Mailing Address - Country:US
Mailing Address - Phone:734-355-8325
Mailing Address - Fax:
Practice Address - Street 1:111 N 1ST ST
Practice Address - Street 2:SUITE 3
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1397
Practice Address - Country:US
Practice Address - Phone:734-355-8325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801065606104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M07270027Medicare ID - Type Unspecified