Provider Demographics
NPI:1801779707
Name:JAVERNICK, QUIANNA ELIZABETH (CCC-SLP)
Entity type:Individual
Prefix:
First Name:QUIANNA
Middle Name:ELIZABETH
Last Name:JAVERNICK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:QUIANNA
Other - Middle Name:ELIZABETH
Other - Last Name:BALLOQUI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1390 NW CONKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1206
Mailing Address - Country:US
Mailing Address - Phone:719-429-1734
Mailing Address - Fax:
Practice Address - Street 1:1390 NW CONKLIN AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1206
Practice Address - Country:US
Practice Address - Phone:719-429-1734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17391235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist