MEDICARE: KEELAN A QUINN PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	C.0900485	OH
2	103T00000X	Psychologist	P.07846	OH

General Provider Information

NPI Number	:	1063892115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEELAN A QUINN PHD

Provider Business Mailing Address
First Line	:	34305 SOLON RD STE 52
Second Line	:
City	:	SOLON
State	:	OH
Zip	:	44139-2660
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	34305 SOLON RD STE 52
Second Line	:
City	:	SOLON
State	:	OH
Zip	:	44139-2660
Country	:	US
Telephone Number	:	440-349-3038
Fax Number	:	440-349-3081

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2015
Last Update Date	:	12/31/2018

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Directions to “ KEELAN A QUINN PHD” Practice Location

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