Provider Demographics
NPI:1982984811
Name:DILLON, MICHELLE LYNN (SLP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LYNN
Last Name:DILLON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:DILLON
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:505 QUAIL CIR
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-4002
Mailing Address - Country:US
Mailing Address - Phone:281-910-1888
Mailing Address - Fax:
Practice Address - Street 1:310 ODYSSEY DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-1646
Practice Address - Country:US
Practice Address - Phone:281-480-5648
Practice Address - Fax:281-480-5691
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist