1730447657 NPI number — MR. ANTHONY SCOTT DILLON M.A., LCPC, CHT

Table of content: MR. ANTHONY SCOTT DILLON M.A., LCPC, CHT (NPI 1730447657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730447657 NPI number — MR. ANTHONY SCOTT DILLON M.A., LCPC, CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DILLON
Provider First Name:
ANTHONY
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.A., LCPC, CHT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730447657
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7956 BIRCH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMMOND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46324-3329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-781-1113
Provider Business Mailing Address Fax Number:
219-844-0195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1314 KENSINGTON RD UNIT 4531
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK BROOK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60522-7136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-324-4996
Provider Business Practice Location Address Fax Number:
219-844-0195
Provider Enumeration Date:
04/28/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 180008405 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1780223529 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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