Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1235508029 |
---|---|
Provider Name | Jon Dillow |
First Address | Savoy, IL 61874-7468 |
Second Address | Savoy, IL 61874-7468 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2015 |
Last Update Date | 22/09/2015 |