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General NPI Number Information
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NPI Number | 1427053784
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Entity Type | Individual
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Provider Name | MARC A QUILLEN PH.D
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Gender | Male
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 03/23/2009
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Provider Practice Location Address
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Address Line | 4217 BRIARWOOD DR
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City | LAWRENCE
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State | KS
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Zip | 66049-1998
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Country | US
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Telephone | 785-856-0684
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Fax |
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Provider Business Mailing Address
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Address Line | 4217 BRIARWOOD DR
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City | LAWRENCE
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State | KS
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Zip | 66049-1998
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Country | US
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Telephone | 785-856-0684
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 0521
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0521
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License Number State | KS
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