Provider Demographics
NPI:1972939866
Name:DILLON, SHANNON MCKEE
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MCKEE
Last Name:DILLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 FULTON ST
Mailing Address - Street 2:APARTMENT A
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-3228
Mailing Address - Country:US
Mailing Address - Phone:530-448-2801
Mailing Address - Fax:
Practice Address - Street 1:2607 FULTON ST
Practice Address - Street 2:APARTMENT A
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704
Practice Address - Country:US
Practice Address - Phone:530-448-2801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61055150103TC0700X
CA31688103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical