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General NPI Number Information
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NPI Number | 1275822397
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Entity Type | Individual
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Provider Name | NICHOLAS DILLON M.S., M.A., SACIT
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Gender | Male
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Dates
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Enumeration Date | 03/29/2011
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Last Update Date | 04/07/2017
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Provider Practice Location Address
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Address Line | 1177 QUAIL CT SUITE 203
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City | PEWAUKEE
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State | WI
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Zip | 53072-3790
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Country | US
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Telephone | 262-691-2980
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Fax | 262-691-4966
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Provider Business Mailing Address
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Address Line | 3815 N BROOKFIELD RD SUITE 104-141
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City | BROOKFIELD
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State | WI
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Zip | 53045-1964
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Country | US
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Telephone | 866-305-9818
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Fax | 262-691-4966
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 16137-131
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License Number State | WI
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