Provider Demographics
NPI:1548477094
Name:QUINN, ROXANNE HAZEL (LPC)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:HAZEL
Last Name:QUINN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21898 LINCOLN TER
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:KS
Mailing Address - Zip Code:66083-7532
Mailing Address - Country:US
Mailing Address - Phone:913-484-2443
Mailing Address - Fax:
Practice Address - Street 1:13839 S MUR LEN RD STE K
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1662
Practice Address - Country:US
Practice Address - Phone:913-764-5463
Practice Address - Fax:913-764-4160
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS948101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS37909013Medicare UPIN