Provider Demographics
NPI:1144388133
Name:QUINN, E KELLI (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:E
Middle Name:KELLI
Last Name:QUINN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 AMSTER GREEN DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-4139
Mailing Address - Country:US
Mailing Address - Phone:770-851-9553
Mailing Address - Fax:770-698-4178
Practice Address - Street 1:1000 HOLCOMB WOODS PKWY
Practice Address - Street 2:STE 426
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2575
Practice Address - Country:US
Practice Address - Phone:770-851-9553
Practice Address - Fax:770-698-4178
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005554235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA971452OtherBCBS PIN
GA290890024CMedicaid