Individual
MRS. KELLY LYNN DILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CAGS, NCC
Contact information
Practice address
409 E PARK ST, BENTON, IL 62812-1920
(618) 439-7231
Mailing address
PO BOX 1027, BENTON, IL 62812-5027
(618) 439-7231
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1816584
STATE EDUCATOR LICENSE ID
IL
Enumeration date
07/31/2020
Last updated
07/31/2020
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