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General NPI Number Information
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NPI Number | 1770050122
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Entity Type | Individual
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Provider Name | THERESA QUEDNAU
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Gender | Female
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Dates
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Enumeration Date | 10/24/2018
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Last Update Date | 10/11/2023
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Provider Practice Location Address
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Address Line | 2916 CROSSING CT STE B
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City | CHAMPAIGN
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State | IL
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Zip | 61822-5900
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Country | US
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Telephone | 217-693-7085
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Fax |
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Provider Business Mailing Address
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Address Line | 2916 CROSSING CT STE B
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City | CHAMPAIGN
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State | IL
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Zip | 61822-5900
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Country | US
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Telephone | 217-693-7085
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | EH018812
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number | 3291
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License Number State | IL
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