Provider Demographics
NPI:1801164496
Name:DILLON, VERONICA ICHIKAWA
Entity type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:ICHIKAWA
Last Name:DILLON
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:ICHIKAWA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:5600 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9368
Mailing Address - Country:US
Mailing Address - Phone:734-484-6911
Mailing Address - Fax:
Practice Address - Street 1:5600 MEADOW DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9368
Practice Address - Country:US
Practice Address - Phone:734-484-6911
Practice Address - Fax:734-484-6913
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2063630103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist