Provider Demographics
NPI:1174511950
Name:RILEY-QUINN, KIMBERLY A (LISW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:RILEY-QUINN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 E 38TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-1135
Mailing Address - Country:US
Mailing Address - Phone:563-359-4049
Mailing Address - Fax:563-359-4069
Practice Address - Street 1:2102 E 38TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-1135
Practice Address - Country:US
Practice Address - Phone:563-359-4049
Practice Address - Fax:563-359-4069
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA010551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0448159Medicaid
IA35389OtherWELLMARK HEALTH PLAN
IA01K8OtherJOHN DEERE HEALTH PLAN
IA35389OtherWELLMARK HEALTH PLAN
IAI10484Medicare ID - Type UnspecifiedMEDICARE NUMBER