Healthcare Provider Details

I. General information

NPI: 1376989855
Provider Name (Legal Business Name): QUOTABLE KIDS PEDIATRIC THERAPY CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 DEMERS AVENUE SUITE 101
GRAND FORKS ND
58201
US

IV. Provider business mailing address

2600 DEMERS AVENUE SUITE 101
GRAND FORKS ND
58201
US

V. Phone/Fax

Practice location:
  • Phone: 701-739-5437
  • Fax: 701-746-9198
Mailing address:
  • Phone: 701-739-5437
  • Fax: 701-746-9198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number1070
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANDREA VOLK
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: M.A. CCC-SLP
Phone: 701-741-8057