Healthcare Provider Details

I. General information

NPI: 1386558823
Provider Name (Legal Business Name): JENNIFER QUINN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1443 CORPORATE WAY
SEYMOUR IN
47274-3391
US

IV. Provider business mailing address

169 HAUSER CT S
HOPE IN
47246-9693
US

V. Phone/Fax

Practice location:
  • Phone: 812-522-4341
  • Fax:
Mailing address:
  • Phone: 812-350-4260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number88001498A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: