Healthcare Provider Details

I. General information

NPI: 1265217202
Provider Name (Legal Business Name): ROSALIE BLACKBURN DILLON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date: 08/19/2026
Reactivation Date: 09/10/2026

III. Provider practice location address

1019 SW 152ND ST
BURIEN WA
98166-1845
US

IV. Provider business mailing address

401 MONTELLO AVE
HOOD RIVER OR
97031-2150
US

V. Phone/Fax

Practice location:
  • Phone: 206-242-1698
  • Fax:
Mailing address:
  • Phone: 541-399-7206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: