Provider Demographics
NPI:1255584454
Name:QUINTO, SUSAN L (CCC/SP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:L
Last Name:QUINTO
Suffix:
Gender:F
Credentials:CCC/SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SUNSET CT
Mailing Address - Street 2:
Mailing Address - City:APALACHIN
Mailing Address - State:NY
Mailing Address - Zip Code:13732-4215
Mailing Address - Country:US
Mailing Address - Phone:607-625-4804
Mailing Address - Fax:
Practice Address - Street 1:11 SUNSET CT
Practice Address - Street 2:
Practice Address - City:APALACHIN
Practice Address - State:NY
Practice Address - Zip Code:13732-4215
Practice Address - Country:US
Practice Address - Phone:607-625-4804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005531235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist