Healthcare Provider Details

I. General information

NPI: 1114857554
Provider Name (Legal Business Name): JANICE-MARIE DILLON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 ADAMS BLVD
BOULDER CITY NV
89005-2213
US

IV. Provider business mailing address

22 DURANGO STATION DR
HENDERSON NV
89012-2265
US

V. Phone/Fax

Practice location:
  • Phone: 773-865-5069
  • Fax:
Mailing address:
  • Phone: 773-865-5069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12264-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: