Provider Demographics
NPI:1871140079
Name:QUINTANA, AMANDA MICHELLE (SLP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MICHELLE
Last Name:QUINTANA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-2315
Mailing Address - Country:US
Mailing Address - Phone:415-637-0835
Mailing Address - Fax:
Practice Address - Street 1:1331 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-2315
Practice Address - Country:US
Practice Address - Phone:415-637-0835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2023-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program