Provider Demographics
NPI:1760631808
Name:QUINN, FREDERICK DOUGLAS (LCPC, NCC, DAPA)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:DOUGLAS
Last Name:QUINN
Suffix:
Gender:M
Credentials:LCPC, NCC, DAPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 W FRONTAGE RD
Mailing Address - Street 2:SUITE 2115
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-1250
Mailing Address - Country:US
Mailing Address - Phone:847-337-7846
Mailing Address - Fax:
Practice Address - Street 1:540 W. FRONTAGE ROAD
Practice Address - Street 2:SUITE 2115
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-1291
Practice Address - Country:US
Practice Address - Phone:847-337-7846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-005700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL060-008928OtherREGISTERED PROFESSIONAL SERVICE CORP.
IL180-005700OtherDEPT OF FIN AND PRO. REGULATION