Provider Demographics
NPI:1861935397
Name:DILLON, AMY
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:DILLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:P
Other - Last Name:DILLON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:8643 CALLIE AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2806
Mailing Address - Country:US
Mailing Address - Phone:773-710-9460
Mailing Address - Fax:847-733-5935
Practice Address - Street 1:8643 CALLIE AVE
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2806
Practice Address - Country:US
Practice Address - Phone:773-710-9460
Practice Address - Fax:847-733-5935
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490109521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical