Provider Demographics
NPI:1710013529
Name:QUINN, AMI GRACE (MSW, LCS W, PPS)
Entity Type:Individual
Prefix:MS
First Name:AMI
Middle Name:GRACE
Last Name:QUINN
Suffix:
Gender:F
Credentials:MSW, LCS W, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 TANK FARM RD STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7082
Mailing Address - Country:US
Mailing Address - Phone:805-234-2573
Mailing Address - Fax:
Practice Address - Street 1:181 TANK FARM RD STE 120
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7082
Practice Address - Country:US
Practice Address - Phone:805-342-2573
Practice Address - Fax:805-542-0867
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA205611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical