Provider Demographics
NPI:1184132912
Name:DILLON, MILISSA J (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MILISSA
Middle Name:J
Last Name:DILLON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 MONTICELLO DR
Mailing Address - Street 2:
Mailing Address - City:FT WRIGHT
Mailing Address - State:KY
Mailing Address - Zip Code:41011-3670
Mailing Address - Country:US
Mailing Address - Phone:859-250-8261
Mailing Address - Fax:
Practice Address - Street 1:141 LLOYD RD
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-8974
Practice Address - Country:US
Practice Address - Phone:937-544-5586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-15
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12888235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist