Provider Demographics
NPI:1639397029
Name:QUESNELL, THOMAS C (MS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:QUESNELL
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 18TH ST
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3716
Mailing Address - Country:US
Mailing Address - Phone:563-421-1400
Mailing Address - Fax:563-421-1410
Practice Address - Street 1:1227 E RUSHOLME ST
Practice Address - Street 2:DEPT OF SPEECH AND HEARING
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2459
Practice Address - Country:US
Practice Address - Phone:563-421-1400
Practice Address - Fax:563-421-1410
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA415231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA717OtherHEARING AID DEALER LIC