Provider Demographics
NPI:1407642515
Name:DILLINGHAM, NOELIA
Entity type:Individual
Prefix:
First Name:NOELIA
Middle Name:
Last Name:DILLINGHAM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13500 RIVERPORT DR
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-4856
Mailing Address - Country:US
Mailing Address - Phone:314-988-1030
Mailing Address - Fax:314-988-0954
Practice Address - Street 1:13500 RIVERPORT DR
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-4856
Practice Address - Country:US
Practice Address - Phone:314-988-1030
Practice Address - Fax:314-988-0954
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter