Provider Demographics
NPI:1336388701
Name:DUDEK, QUINCEY MARIE
Entity type:Individual
Prefix:MRS
First Name:QUINCEY
Middle Name:MARIE
Last Name:DUDEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:QUINCEY
Other - Middle Name:M
Other - Last Name:DUDEK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:303 MORNING KILL RUN
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-3760
Mailing Address - Country:US
Mailing Address - Phone:518-885-6724
Mailing Address - Fax:
Practice Address - Street 1:597 3RD AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12182-2509
Practice Address - Country:US
Practice Address - Phone:518-233-0544
Practice Address - Fax:518-233-0703
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005351-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist