Provider Demographics
NPI:1972647626
Name:DILLEY, JOHN BRIAN (EDD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRIAN
Last Name:DILLEY
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:B
Other - Last Name:DILLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PLC
Mailing Address - Street 1:1350 NW 138TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8377
Mailing Address - Country:US
Mailing Address - Phone:515-223-4188
Mailing Address - Fax:515-223-9570
Practice Address - Street 1:1350 NW 138TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50325-8377
Practice Address - Country:US
Practice Address - Phone:515-223-4188
Practice Address - Fax:515-223-9570
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA376103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1229OtherPROF. MOBILITY (ASPPB)
IA376OtherPSYCHOLOGIST
IA123OtherHEALTH SERVICE PROVIDER
IA376OtherPSYCHOLOGIST
IAR04364Medicare UPIN