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NPI Code Detail

MEDICARE: KELLY QUIN PREJEAN CCC-SLP

MEDICARE: KELLY QUIN PREJEAN CCC-SLP
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
1222Q00000XDevelopmental TherapistSA8498FL
2235Z00000XSpeech-Language PathologistSA 8498FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477502011
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY QUIN PREJEAN CCC-SLP
Provider Business Mailing Address
First Line : 2306 LIMERICK DR
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32309-3509
Country : US
Telephone Number : 321-947-4389
Fax Number :
Provider Business Practice Location Address
First Line : 1725 HERMITAGE BLVD
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32308-7709
Country : US
Telephone Number : 850-325-6301
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2006
Last Update Date : 06/17/2021

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Directions to “ KELLY QUIN PREJEAN CCC-SLP” Practice Location

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