MEDICARE: DR. JOHN BRIAN DILLEY ED.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	376	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1229	OTHER	IA	PROF. MOBILITY (ASPPB)
2	376	OTHER	IA	PSYCHOLOGIST
3	123	OTHER	IA	HEALTH SERVICE PROVIDER

General Provider Information

NPI Number	:	1972647626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN BRIAN DILLEY ED.D.

Provider Business Mailing Address
First Line	:	1350 NW 138TH ST
Second Line	:	SUITE 200
City	:	DES MOINES
State	:	IA
Zip	:	50325-8377
Country	:	US
Telephone Number	:	515-223-4188
Fax Number	:	515-223-9570

Provider Business Practice Location Address
First Line	:	1350 NW 138TH ST
Second Line	:	SUITE 200
City	:	DES MOINES
State	:	IA
Zip	:	50325-8377
Country	:	US
Telephone Number	:	515-223-4188
Fax Number	:	515-223-9570

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	07/08/2007

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