Provider Demographics
NPI:1093196735
Name:QUINTERO, DANIELA (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:QUINTERO
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 3RD ST APT 1302
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-1737
Mailing Address - Country:US
Mailing Address - Phone:806-626-1234
Mailing Address - Fax:
Practice Address - Street 1:3501 S LOOP 289
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1139
Practice Address - Country:US
Practice Address - Phone:806-796-1774
Practice Address - Fax:806-796-1717
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109034235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist