Provider Demographics
NPI:1972125615
Name:DILLE, JO (PSYD)
Entity type:Individual
Prefix:DR
First Name:JO
Middle Name:
Last Name:DILLE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 N SAINT LOUIS AVE APT 1A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1286
Mailing Address - Country:US
Mailing Address - Phone:215-272-1633
Mailing Address - Fax:
Practice Address - Street 1:53 W JACKSON BLVD STE 1018
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3655
Practice Address - Country:US
Practice Address - Phone:773-234-7719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-16
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071011105103TC0700X
KS3256103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical