Individual
DR. MARC A QUILLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D
Contact information
Practice address
4217 BRIARWOOD DR, LAWRENCE, KS 66049-1998
(785) 856-0684
Mailing address
4217 BRIARWOOD DR, LAWRENCE, KS 66049-1998
(785) 856-0684
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
0521
KS
103TC0700X
Clinical Psychologist
Primary
0521
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100230310B
—
KS
Enumeration date
06/14/2005
Last updated
03/23/2009
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