Healthcare Provider Details

I. General information

NPI: 1073663357
Provider Name (Legal Business Name): RACHEL MARIE QUAM MSCCCSLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 7TH ST NE
DEVILS LAKE ND
58301-2530
US

IV. Provider business mailing address

412 7TH ST NE
DEVILS LAKE ND
58301-2530
US

V. Phone/Fax

Practice location:
  • Phone: 701-347-1188
  • Fax: 701-401-5154
Mailing address:
  • Phone: 701-347-1188
  • Fax: 701-402-5154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number742
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: