Provider Demographics
NPI:1316489545
Name:QUINTANILLA, WENDY R (MS CCC-SLP,TSSLD,B)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:R
Last Name:QUINTANILLA
Suffix:
Gender:F
Credentials:MS CCC-SLP,TSSLD,B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 FAILE ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-3703
Mailing Address - Country:US
Mailing Address - Phone:646-406-7678
Mailing Address - Fax:
Practice Address - Street 1:984 FAILE ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-3703
Practice Address - Country:US
Practice Address - Phone:718-589-2733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-04
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214821235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1316489545Medicaid