Provider Demographics
NPI:1114688249
Name:QUINN, ANDREA ROSE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:ROSE
Last Name:QUINN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 GAYMAN CT
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IL
Mailing Address - Zip Code:61415-9024
Mailing Address - Country:US
Mailing Address - Phone:309-229-6152
Mailing Address - Fax:
Practice Address - Street 1:834 NORTH SEMINARY STREET
Practice Address - Street 2:SUITE 405
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401
Practice Address - Country:US
Practice Address - Phone:309-344-9444
Practice Address - Fax:309-717-0124
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490229911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical