Provider Demographics
NPI:1033786744
Name:MCQUISTON, JOYCE (ABS & ASD SPECIALIST)
Entity Type:Individual
Prefix:MS
First Name:JOYCE
Middle Name:
Last Name:MCQUISTON
Suffix:
Gender:F
Credentials:ABS & ASD SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 SAHLMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-2516
Mailing Address - Country:US
Mailing Address - Phone:218-390-4755
Mailing Address - Fax:
Practice Address - Street 1:4891 MILLER TRUNK HWY STE 104
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811-1579
Practice Address - Country:US
Practice Address - Phone:218-302-1966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN347012103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN347012OtherMN PROFESSIONAL BOARD OF LICENSING