Provider Demographics
NPI:1891964060
Name:QUARLES, PHYLLIS JANE (MA CCC SLP C)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:JANE
Last Name:QUARLES
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Gender:F
Credentials:MA CCC SLP C
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Mailing Address - Street 1:489 MAIN STREET POMEROY HALL
Mailing Address - Street 2:UNIVERSITY OF VERMONT ELEANOR M LUSE CTR
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05405-0130
Mailing Address - Country:US
Mailing Address - Phone:802-656-3861
Mailing Address - Fax:802-656-2528
Practice Address - Street 1:489 MAIN STREET POMEROY HALL
Practice Address - Street 2:UNIVERSITY OF VERMONT ELEANOR M LUSE CTR
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05405-0130
Practice Address - Country:US
Practice Address - Phone:802-656-3861
Practice Address - Fax:802-656-2528
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
01101951235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist