Provider Demographics
NPI:1578361861
Name:MCCLAIN, QUINTIA
Entity type:Individual
Prefix:
First Name:QUINTIA
Middle Name:
Last Name:MCCLAIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15430 DIEKMAN CT
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419-3124
Mailing Address - Country:US
Mailing Address - Phone:773-331-4505
Mailing Address - Fax:
Practice Address - Street 1:15430 DIEKMAN CT
Practice Address - Street 2:
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419-3124
Practice Address - Country:US
Practice Address - Phone:773-331-4505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician