Provider Demographics
NPI:1407394869
Name:DILLON, JOLEEN (SPEECH/LANGUAGE PATH)
Entity type:Individual
Prefix:
First Name:JOLEEN
Middle Name:
Last Name:DILLON
Suffix:
Gender:F
Credentials:SPEECH/LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 276
Mailing Address - Street 2:720 TOWNSHIP RD 134
Mailing Address - City:MCCOMB
Mailing Address - State:OH
Mailing Address - Zip Code:45858
Mailing Address - Country:US
Mailing Address - Phone:419-348-2932
Mailing Address - Fax:
Practice Address - Street 1:1920 SLABTOWN RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3309
Practice Address - Country:US
Practice Address - Phone:419-222-1836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 6439235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist