Provider Demographics
NPI:1922127588
Name:QUEEN, DARLA JUNE (BC-HIS)
Entity Type:Individual
Prefix:MRS
First Name:DARLA
Middle Name:JUNE
Last Name:QUEEN
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARK HILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63601-2540
Mailing Address - Country:US
Mailing Address - Phone:573-431-3633
Mailing Address - Fax:573-431-4971
Practice Address - Street 1:120 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PARK HILLS
Practice Address - State:MO
Practice Address - Zip Code:63601-2540
Practice Address - Country:US
Practice Address - Phone:573-431-3633
Practice Address - Fax:573-431-4971
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO752237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist