Provider Demographics
NPI:1053180687
Name:QUINN, COLLEEN JANE (ITDS)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:JANE
Last Name:QUINN
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12138 SW BENNINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2781
Mailing Address - Country:US
Mailing Address - Phone:419-360-8121
Mailing Address - Fax:
Practice Address - Street 1:12138 SW BENNINGTON CIR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2781
Practice Address - Country:US
Practice Address - Phone:419-360-8121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist