Provider Demographics
NPI:1235264045
Name:QUINN, ANGELIA D (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELIA
Middle Name:D
Last Name:QUINN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9210 BACKWATER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-4133
Mailing Address - Country:US
Mailing Address - Phone:317-578-0121
Mailing Address - Fax:317-578-0856
Practice Address - Street 1:9210 BACKWATER DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-4133
Practice Address - Country:US
Practice Address - Phone:317-578-0121
Practice Address - Fax:317-578-0856
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2008-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004361A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist