Provider Demographics
NPI:1568243947
Name:ESLAVA, QUENNIE YHEN
Entity type:Individual
Prefix:
First Name:QUENNIE
Middle Name:YHEN
Last Name:ESLAVA
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 1:24000 VAN RY BLVD APT 647
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-5485
Mailing Address - Country:US
Mailing Address - Phone:253-426-9856
Mailing Address - Fax:
Practice Address - Street 1:19401 40TH AVE W STE 100
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5600
Practice Address - Country:US
Practice Address - Phone:253-426-9856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2024-10-22
Deactivation Date:2024-01-17
Deactivation Code:
Reactivation Date:2024-10-22
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst