Provider Demographics
NPI:1033242128
Name:QUELLIER, JEROME MARCOUILLER (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:JEROME
Middle Name:MARCOUILLER
Last Name:QUELLIER
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JEROME
Other - Middle Name:FRANCIS
Other - Last Name:MARCOUILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:640 JACKSON STREET
Mailing Address - Street 2:MAIL STOP 11102D REGIONS HOSPITAL
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101
Mailing Address - Country:US
Mailing Address - Phone:651-254-9281
Mailing Address - Fax:
Practice Address - Street 1:435 PHALEN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-5302
Practice Address - Country:US
Practice Address - Phone:651-254-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6362235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist