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General NPI Number Information
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NPI Number | 1235728783
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Entity Type | Individual
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Provider Name | MARISSA KIMBERLY DILLON SLPA
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Gender | Female
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Dates
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Enumeration Date | 01/11/2021
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Last Update Date | 01/11/2021
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Provider Practice Location Address
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Address Line | 1111 N 64TH ST UNIT 5
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City | MESA
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State | AZ
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Zip | 85205-5608
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Country | US
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Telephone | 480-544-1214
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 N 64TH ST UNIT 5
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City | MESA
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State | AZ
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Zip | 85205-5608
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Country | US
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Telephone | 480-544-1214
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | SLPA12776
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License Number State | AZ
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