Provider Demographics
NPI:1780779058
Name:DILLIN, SANDRA (LPEI)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:DILLIN
Suffix:
Gender:F
Credentials:LPEI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 HIGHGATE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-7967
Mailing Address - Country:US
Mailing Address - Phone:501-305-1403
Mailing Address - Fax:
Practice Address - Street 1:1836 FREMONT ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2537
Practice Address - Country:US
Practice Address - Phone:541-414-1720
Practice Address - Fax:541-414-1721
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AR96-16EI101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health