Provider Demographics
NPI:1720568512
Name:JONFE-QUINTO, MELISSA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:JONFE-QUINTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 BLUFF SPRINGS ROAD
Mailing Address - Street 2:APT 616
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744
Mailing Address - Country:US
Mailing Address - Phone:630-890-3292
Mailing Address - Fax:
Practice Address - Street 1:8300 BLUFF SPRINGS ROAD
Practice Address - Street 2:APT 616
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744
Practice Address - Country:US
Practice Address - Phone:630-890-3292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.014229235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist