Active NPI
Dyllin Nicole Bolen
- Music Therapist
- Fort Wayne, IN
National Provider Identifier
1194506980
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Music Therapist
- License
- 17860
- Practice address
- 1910 Saint Joe Center Rd
Fort Wayne, IN 46825-5000 - Phone
- (260) 494-1624
- NPI assigned
- Oct 9, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Music Therapist | 225A00000X | 17860 | IN | Primary |
Addresses
Primary practice location
1910 Saint Joe Center Rd
Fort Wayne, IN 46825-5000
Mailing address
1910 Saint Joe Center Rd
Fort Wayne, IN 46825-5000
Phone (260) 615-1782
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17860 | IN | MD | Music Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1696809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696809600000",
"number": "1194506980",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1910 SAINT JOE CENTER RD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468255000",
"telephone_number": "260-615-1782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1910 SAINT JOE CENTER RD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468255000",
"telephone_number": "260-494-1624"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLEN",
"first_name": "DYLLIN",
"middle_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-10-09",
"last_updated": "2023-10-09",
"certification_date": "2023-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "225A00000X",
"taxonomy_group": "",
"desc": "Music Therapist",
"state": "IN",
"license": "17860",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.