Provider Demographics
NPI:1649995598
Name:MULDOON, QUINTIN TODD
Entity type:Individual
Prefix:
First Name:QUINTIN
Middle Name:TODD
Last Name:MULDOON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 COMMERCIAL ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-1049
Mailing Address - Country:US
Mailing Address - Phone:503-983-9900
Mailing Address - Fax:
Practice Address - Street 1:960 LIBERTY ST SE STE 120
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4165
Practice Address - Country:US
Practice Address - Phone:503-588-2804
Practice Address - Fax:503-371-6743
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)