Individual
JILL DIMITRI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ST
Contact information
Practice address
2555 COUNTY ROAD E E # 102, WHITE BEAR LAKE, MN 55110-4906
(651) 683-2953
Mailing address
150 LOST LAKE CT, MAHTOMEDI, MN 55115-1865
(309) 830-6216
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
9503
MN
Other
Enumeration date
10/18/2006
Last updated
10/02/2019
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