Healthcare Provider Details

I. General information

NPI: 1811416670
Provider Name (Legal Business Name): GINA DILLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 1ST AVE NW STE 200
ROCHESTER MN
55901-2830
US

IV. Provider business mailing address

300 1ST AVE NW STE 200
ROCHESTER MN
55901-2830
US

V. Phone/Fax

Practice location:
  • Phone: 507-292-1600
  • Fax: 507-292-1600
Mailing address:
  • Phone: 507-292-1600
  • Fax: 507-292-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. GINA ARLINE DILLY
Title or Position: LICENSED PSYCHOLOGIST
Credential: LP
Phone: 507-292-1600