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General NPI Number Information
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NPI Number | 1972647626
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Entity Type | Individual
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Provider Name | JOHN BRIAN DILLEY ED.D.
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Gender | Male
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1350 NW 138TH ST SUITE 200
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City | DES MOINES
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State | IA
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Zip | 50325-8377
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Country | US
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Telephone | 515-223-4188
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Fax | 515-223-9570
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Provider Business Mailing Address
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Address Line | 1350 NW 138TH ST SUITE 200
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City | DES MOINES
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State | IA
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Zip | 50325-8377
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Country | US
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Telephone | 515-223-4188
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Fax | 515-223-9570
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 376
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License Number State | IA
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