=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417169103
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHLEEN MARY QUINLISK PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 506 E LANCASTER AVE
-----------------------------------------------------
City | DOWNINGTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19335-2776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-518-6020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 E GOLF CLUB LN
-----------------------------------------------------
City | PAOLI
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19301-1514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-722-5961
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PS008269L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------