Provider Demographics
NPI:1700380730
Name:QUINTANILLA, LISA MONIQUE (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MONIQUE
Last Name:QUINTANILLA
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10115 DOS CERROS DR
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-5121
Mailing Address - Country:US
Mailing Address - Phone:210-386-7221
Mailing Address - Fax:
Practice Address - Street 1:18 SCENIC LOOP RD STE 200A
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-8606
Practice Address - Country:US
Practice Address - Phone:830-755-6091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113515235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist