Provider Demographics
NPI:1912564832
Name:EMERY, QUIANA NICOLE (RBT-19-79973)
Entity Type:Individual
Prefix:
First Name:QUIANA
Middle Name:NICOLE
Last Name:EMERY
Suffix:
Gender:F
Credentials:RBT-19-79973
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 W 71ST PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60636-4151
Mailing Address - Country:US
Mailing Address - Phone:773-575-4996
Mailing Address - Fax:
Practice Address - Street 1:1335 W 71ST PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60636-4151
Practice Address - Country:US
Practice Address - Phone:773-575-4996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-27
Last Update Date:2019-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-19-79973106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician