MEDICARE: DR. DARREN JILEK PH.D.

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	103T00000X	Psychologist	536	SD

General Provider Information

NPI Number	:	1215300066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARREN JILEK PH.D.

Provider Business Mailing Address
First Line	:	39218 PRAIRIE RD
Second Line	:
City	:	MELLETTE
State	:	SD
Zip	:	57461-5206
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	39218 PRAIRIE RD
Second Line	:
City	:	MELLETTE
State	:	SD
Zip	:	57461-5206
Country	:	US
Telephone Number	:	605-228-4877
Fax Number	:

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

Provider Enumeration Date	:	11/02/2015
Last Update Date	:	12/09/2015

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