Healthcare Provider Details

I. General information

NPI: 1063727600
Provider Name (Legal Business Name): JARED A DILLOW LPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 QUEBEC WAY
LEXINGTON KY
40515-4626
US

IV. Provider business mailing address

161 QUEBEC WAY
LEXINGTON KY
40515-4626
US

V. Phone/Fax

Practice location:
  • Phone: 606-694-6466
  • Fax:
Mailing address:
  • Phone: 606-694-6466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number246627
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: