Basic Information
| Provider Information | |||||||||
| NPI: | 1598167751 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUINTAL | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MS, BCBA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ROSSER | ||||||||
| OtherFirstName: | ASHLEY | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 45-133 KA HANAHOU CIR | ||||||||
| Address2: | |||||||||
| City: | KANEOHE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967443008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8087412232 | ||||||||
| FaxNumber: | 8888234568 | ||||||||
| Practice Location | |||||||||
| Address1: | 45-133 KA HANAHOU CIR | ||||||||
| Address2: | |||||||||
| City: | KANEOHE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967443008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8087412232 | ||||||||
| FaxNumber: | 8888234568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2014 | ||||||||
| LastUpdateDate: | 09/19/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.