Provider Demographics
NPI:1588973929
Name:QUINLEY, MARY-JENNIFER ELIZABETH (MS)
Entity type:Individual
Prefix:MRS
First Name:MARY-JENNIFER
Middle Name:ELIZABETH
Last Name:QUINLEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 30
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:64683-0030
Mailing Address - Country:US
Mailing Address - Phone:660-359-4487
Mailing Address - Fax:660-359-2958
Practice Address - Street 1:304 E LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:NEW HAMPTON
Practice Address - State:MO
Practice Address - Zip Code:64471-0222
Practice Address - Country:US
Practice Address - Phone:660-439-2060
Practice Address - Fax:660-439-2061
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010033597101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO494359300Medicaid