Provider Demographics
NPI:1083922371
Name:QUIJANO, LOURDES F (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:F
Last Name:QUIJANO
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5429 69TH LN
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1816
Mailing Address - Country:US
Mailing Address - Phone:347-755-7500
Mailing Address - Fax:
Practice Address - Street 1:10915 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5482
Practice Address - Country:US
Practice Address - Phone:347-755-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018761235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist