Healthcare Provider Details

I. General information

NPI: 1639397029
Provider Name (Legal Business Name): THOMAS C QUESNELL M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 E RUSHOLME ST DEPT OF SPEECH AND HEARING
DAVENPORT IA
52803-2459
US

IV. Provider business mailing address

1915 18TH ST
BETTENDORF IA
52722-3716
US

V. Phone/Fax

Practice location:
  • Phone: 563-421-1400
  • Fax: 563-421-1410
Mailing address:
  • Phone: 563-421-1400
  • Fax: 563-421-1410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number415
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier717
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerHEARING AID DEALER LIC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: