Jacqueline Mary Quinn-Tan, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

20041167A Issued in IN

Practice address

1000 S Michigan St
South Bend, IN 46601-3426

Phone

(574) 235-5408

NPI assigned

Nov 11, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1226361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629849600000",
    "number": "1518111996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1540 TRINITY PL",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465455006",
            "telephone_number": "574-272-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 S MICHIGAN ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466013426",
            "telephone_number": "574-235-5408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUINN-TAN",
        "first_name": "JACQUELINE",
        "middle_name": "MARY",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-11-11",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20041167A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Jayadeva Puthran
• Gina B Putt, MA
• Monee Quast, MA
• Katelynne Quick, RBT
• Melissa Christine Quimby, NP
• Cheryl Quiogue-Hunt, LSW
• R.L. Wilson, M.D., PC
• Kelly Gail Racek, PHARMD
• Rachel Mickelson
• Joyce Ellen Racz, MSN, FNP-C, RN

• Clinical Psychologist in South Bend, IN
• Providers in South Bend, IN by specialty
• Clinical Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.