Provider Demographics
NPI:1952536484
Name:QUELLEY, AMANDA ELAINE (BA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELAINE
Last Name:QUELLEY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 74
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:IA
Mailing Address - Zip Code:50641-0074
Mailing Address - Country:US
Mailing Address - Phone:319-238-3132
Mailing Address - Fax:319-636-2022
Practice Address - Street 1:315 MAIN STREET,
Practice Address - Street 2:SUITE F
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613
Practice Address - Country:US
Practice Address - Phone:319-415-9720
Practice Address - Fax:319-636-2022
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health