Healthcare Provider Details

I. General information

NPI: 1639096274
Provider Name (Legal Business Name): CASEY MICHELLE DILLON-CHIPMAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2081 COLLIER CORPORATE PKWY
SAINT CHARLES MO
63303-6701
US

IV. Provider business mailing address

24 TYLER CT
WENTZVILLE MO
63385-4665
US

V. Phone/Fax

Practice location:
  • Phone: 636-736-0778
  • Fax:
Mailing address:
  • Phone: 314-681-2212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2026031263
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: