MEDICARE: MIRJAM QUINN AND ASSOCIATES, LTD

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	103TC0700X	Clinical Psychologist	071.007554	IL

General Provider Information

NPI Number	:	1730577685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRJAM QUINN AND ASSOCIATES, LTD

Provider Business Mailing Address
First Line	:	10801 S WESTERN AVE STE 2B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-3225
Country	:	US
Telephone Number	:	708-586-7357
Fax Number	:	773-253-8410

Provider Business Practice Location Address
First Line	:	10801 S WESTERN AVE STE 2B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-3225
Country	:	US
Telephone Number	:	708-586-7357
Fax Number	:	773-253-8410

Authorized Official
Title or Position	:	OWNER
Name	:	MIRJAM QUINN
Credential	:	PH.D.
Telephone Number	:	708-586-7357

Provider Enumeration Date	:	12/30/2014
Last Update Date	:	10/23/2023

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