Provider Demographics
NPI:1720519770
Name:DILL, JACQUELINE
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:DILL
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 1:4950 W 23RD ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-5802
Mailing Address - Country:US
Mailing Address - Phone:814-459-2755
Mailing Address - Fax:814-456-4873
Practice Address - Street 1:4950 W 23RD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-5802
Practice Address - Country:US
Practice Address - Phone:814-459-2755
Practice Address - Fax:814-456-4873
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist