Basic Information
| Provider Information | |||||||||
| NPI: | 1639537699 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DILL | ||||||||
| FirstName: | KATIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.ED., BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1112 THORNECREST DR | ||||||||
| Address2: | |||||||||
| City: | JANESVILLE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535461790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477780288 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2990 CAHILL MAIN | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | FITCHBURG | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537117130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088196810 | ||||||||
| FaxNumber: | 6088196811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2016 | ||||||||
| LastUpdateDate: | 02/05/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 133-140 | WI | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.