Provider Demographics
NPI:1184298549
Name:QUEENAN, VYVIAN K (AUD)
Entity type:Individual
Prefix:
First Name:VYVIAN
Middle Name:K
Last Name:QUEENAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:VYVIAN
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 FORSGATE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-5155
Mailing Address - Country:US
Mailing Address - Phone:609-831-0779
Mailing Address - Fax:609-831-0778
Practice Address - Street 1:350 FORSGATE DR STE 103
Practice Address - Street 2:
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-5155
Practice Address - Country:US
Practice Address - Phone:609-831-0779
Practice Address - Fax:609-831-0778
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002952231H00000X
NY14000062806237600000X
NJ41YA00109700237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist