Individual
DR. JACQUELINE MARY QUINN-TAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
1000 S MICHIGAN ST, SOUTH BEND, IN 46601-3426
(574) 235-5408
Mailing address
1540 TRINITY PL, MISHAWAKA, IN 46545-5006
(574) 272-9000
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20041167A
IN
Other
Enumeration date
11/11/2008
Last updated
08/25/2021
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