Provider Demographics
NPI:1942472527
Name:PHILLIPS, NANCY QUINTANILLA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:QUINTANILLA
Last Name:PHILLIPS
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 1:6655 FIRST PARK TEN BLVD
Mailing Address - Street 2:STE. 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-4308
Mailing Address - Country:US
Mailing Address - Phone:210-733-0524
Mailing Address - Fax:210-785-9722
Practice Address - Street 1:6655 FIRST PARK TEN BLVD
Practice Address - Street 2:STE. 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-4308
Practice Address - Country:US
Practice Address - Phone:210-733-0524
Practice Address - Fax:210-785-9722
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235Z00000X235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist