MEDICARE: QUINN H CONNICK MA, BA

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1083127567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUINN H CONNICK MA, BA

Provider Business Mailing Address
First Line	:	9455 N RICHMOND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97203-1650
Country	:	US
Telephone Number	:	831-345-2979
Fax Number	:	541-858-8167

Provider Business Practice Location Address
First Line	:	1219 SE LAFAYETTE ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-3802
Country	:	US
Telephone Number	:	503-765-5733
Fax Number	:

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

Provider Enumeration Date	:	11/07/2017
Last Update Date	:	09/01/2021

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Directions to “ QUINN H CONNICK MA, BA” Practice Location

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