Individual
DR. JILL DICKSON-BAURES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY. D.
Contact information
Practice address
2901 HUNTERS TRL, PORTAGE, WI 53901-3403
(087) 425-5186
(608) 742-4087
Mailing address
6918 W WINDSOR AVE, BERWYN, IL 60402-3334
(708) 745-5277
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3693-057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700287216
—
WI
Enumeration date
09/16/2014
Last updated
02/10/2020
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