Provider Demographics
NPI:1285036111
Name:MCQUADE, TIMOTHY (TIM) DANIEL (EDUCATION SPECIALIST)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY (TIM)
Middle Name:DANIEL
Last Name:MCQUADE
Suffix:
Gender:M
Credentials:EDUCATION SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 FOUNTAIN GROVE DR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506-8733
Mailing Address - Country:US
Mailing Address - Phone:419-633-6250
Mailing Address - Fax:
Practice Address - Street 1:124 S BEECH ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-1601
Practice Address - Country:US
Practice Address - Phone:419-633-6250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTU1014923103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool