DR. JACQUELINE MARY QUINN-TAN (NPI# 1518111996) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518111996 |
| Entity Type | Individual |
| Full Name | DR. JACQUELINE MARY QUINN-TAN |
| Credential | PSY.D. |
| Practice Address |
1000 S Michigan St South Bend IN 46601-3426 |
| Mailing Address |
17280 Weatherstone Ct Granger IN 46530-8919 |
| Practice Telephone | 5742355408 |
| Mailing Telephone | 5742736895 |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2008-11-11 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
20041167A | IN | Behavioral Health & Social Service Providers |
| Street Address |
1000 S MICHIGAN ST |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46601-3426 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487106159 | Ike Shipman | Counselor | 1000 S Michigan St, South Bend, IN 46601-3426 | 2016-10-28 |
| 1598145484 | William Bruinsma | Psychologist | 1000 S Michigan St, South Bend, IN 46601-3426 | 2015-06-04 |
| 1073993002 | Rite of Passage, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 1000 S Michigan St, South Bend, IN 46601-3426 | 2015-06-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447610449 | David Thomas | Hearing Instrument Specialist | 808 S Michigan St., South Bend, IN 46601 | 2016-03-03 |
| 1285072454 | Kevin Francis Cumper | Internal Medicine | 621 Memorial Dr Ste 624, South Bend, IN 46601 | 2013-06-11 |
| 1952605560 | Robert Lusk Bonham | Dentist | 1222 L.w.e., So. Bend, IN 46601 | 2010-12-23 |
| 1649580911 | Daniel Scott Debrule | Psychologist | 211 W. Washington Street, Suite 2311, South Bend, IN 46601 | 2010-10-20 |
| 1528390770 | Luke Alfred White | Internal Medicine | 615 N. Michigan St., Memorial Hospital, C/o Erin Smith, South Bend, IN 46601 | 2010-02-12 |
| 1548497837 | Tmg Home Health Care | Home Health | 108 N Main St #305, South Bend, IN 46601 | 2009-06-15 |
| 1225283039 | Jody L. Hughes | Counselor | 202 S. Michigan Street, Suite 875, South Bend, IN 46601 | 2008-11-20 |
| 1740432574 | Amanda Jayne Quicksall | Social Worker | 611 Lincolnway W, South Bend, IN 46601 | 2008-10-10 |
| 1952565772 | Thomas P Judd | Dentist | 1901 #b Western Avenue, Ihc South Bend, South Bend, IN 46601 | 2008-07-10 |
| 1851590269 | Warren Larry Penrod | Nurse Practitioner | 333 W. Western Ave, South Bend, IN 46601 | 2007-07-16 |
| Find all providers in zip 46601 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346697000 | Alexandra Filia Corning | Psychologist | 1251 N. Eddy Street, Suite 200, South Bend, IN 46530-6258 | 2016-05-23 |
| 1629222088 | Suzanne Courtney | Psychologist | 129 Franklin Pl, South Bend, IN 46601-1543 | 2008-11-12 |
| 1942487483 | David A Smith | Psychologist | 1251 N Eddy St Ste 200, South Bend, IN 46617-1478 | 2008-01-28 |
| 1972727949 | Susan Steibe-pasalich | Psychologist | 201 N Ironwood Dr, South Bend, IN 46615-2517 | 2007-04-12 |
| 1952452534 | Diane Johnson Prosser | Psychologist | 227 N Dixie Way Ste 110, South Bend, IN 46637-3366 | 2007-01-12 |
| 1053476697 | Barbara S Searle | Psychologist | 3603 E Jefferson Blvd, Suiteb, South Bend, IN 46615-3035 | 2006-12-26 |
| 1629144043 | Michael Owen Reed | Psychologist | 220 W Colfax Ave, Ste 400, South Bend, IN 46601-1635 | 2006-11-28 |
| 1902984958 | James F Brogle | Psychologist | 828 E Colfax Ave, South Bend, IN 46617-2804 | 2006-11-01 |
| 1518055565 | Michael Robert Sheehan | Psychologist | 1230 Hillcrest Rd, South Bend, IN 46617-1169 | 2006-10-11 |
| 1376585653 | Heather R Lampton | Psychologist | 4650 Old Cleveland Rd, South Bend, IN 46628-4324 | 2006-06-12 |
| Find all providers in SOUTH BEND | ||||
| City | SOUTH BEND |
| Zip Code | 46601 |
Please comment or provide details below to improve the information on DR. JACQUELINE MARY QUINN-TAN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.