Provider Demographics
NPI:1457199887
Name:QUINTOS, KYLA ISABELLE M
Entity type:Individual
Prefix:
First Name:KYLA ISABELLE
Middle Name:M
Last Name:QUINTOS
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 1:496 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:HASBROUCK HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07604-2712
Mailing Address - Country:US
Mailing Address - Phone:201-957-3983
Mailing Address - Fax:
Practice Address - Street 1:15 FRANKLIN ST STE D
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2146
Practice Address - Country:US
Practice Address - Phone:201-525-8926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTL-4453235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist