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General NPI Number Information
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NPI Number | 1700380730
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Entity Type | Individual
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Provider Name | LISA MONIQUE QUINTANILLA M.S., CF-SLP
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Gender | Female
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Dates
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Enumeration Date | 03/23/2018
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Last Update Date | 03/23/2018
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Provider Practice Location Address
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Address Line | 18 SCENIC LOOP RD STE 200A
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City | BOERNE
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State | TX
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Zip | 78006-8606
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Country | US
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Telephone | 830-755-6091
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Fax |
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Provider Business Mailing Address
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Address Line | 10115 DOS CERROS DR
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City | BOERNE
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State | TX
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Zip | 78006-5121
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Country | US
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Telephone | 210-386-7221
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 113515
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License Number State | TX
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