MEDICARE: BRENDA KAYE QUINN MA, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	2666	MN
2	106H00000X	Marriage & Family Therapist	319-228	WI

General Provider Information

NPI Number	:	1992046957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA KAYE QUINN MA, LMFT

Provider Business Mailing Address
First Line	:	4342 15TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407
Country	:	US
Telephone Number	:	763-227-8778
Fax Number	:	651-266-7850

Provider Business Practice Location Address
First Line	:	4342 15TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407
Country	:	US
Telephone Number	:	763-227-8778
Fax Number	:	651-266-7850

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2013
Last Update Date	:	07/14/2022

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