Provider Demographics
NPI:1205370434
Name:QUINN, NOVA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:NOVA
Middle Name:
Last Name:QUINN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 ARNOLD ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-3010
Mailing Address - Country:US
Mailing Address - Phone:978-771-9843
Mailing Address - Fax:
Practice Address - Street 1:94 ARNOLD ST
Practice Address - Street 2:UNIT 2
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-3010
Practice Address - Country:US
Practice Address - Phone:978-771-9843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI61653235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist