Provider Demographics
NPI:1588110944
Name:DILLON, COLLEEN O (PHD)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:O
Last Name:DILLON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 EVANSTON AVE N STE 408
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8969
Mailing Address - Country:US
Mailing Address - Phone:206-769-8580
Mailing Address - Fax:
Practice Address - Street 1:3417 EVANSTON AVE N STE 408
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8969
Practice Address - Country:US
Practice Address - Phone:206-769-8580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-26
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60116578103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent