Individual
MS. MALLORY K. QUINN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DT
Contact information
Practice address
3040 N. WILTON, CHICAGO, IL 60657
(773) 296-8452
(773) 296-7281
Mailing address
10401 S. SANGAMON, CHICAGO, IL 60628
(773) 776-3685
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MQ15380506P
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MQ15380506P
EARLY INTERVENTION PROVID
IL
Enumeration date
02/28/2007
Last updated
07/08/2007
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