MEDICARE: MICHELLE DILLON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1043927312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE DILLON

Provider Business Mailing Address
First Line	:	2909 INDEPENDENCE ST
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-5044
Country	:	US
Telephone Number	:	573-803-1402
Fax Number	:	573-803-1405

Provider Business Practice Location Address
First Line	:	558 GRAVOIS RD STE L100
Second Line	:
City	:	FENTON
State	:	MO
Zip	:	63026-4134
Country	:	US
Telephone Number	:	636-333-2641
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2022
Last Update Date	:	11/04/2022

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Directions to “ MICHELLE DILLON ” Practice Location

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