Provider Demographics
NPI:1255699385
Name:QUEEN, JESSICA R (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:QUEEN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 MURFREESBORO PIKE
Mailing Address - Street 2:APT 141
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-3299
Mailing Address - Country:US
Mailing Address - Phone:615-220-5796
Mailing Address - Fax:
Practice Address - Street 1:301 WOLVERINE TRL
Practice Address - Street 2:SUITE 201
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-5656
Practice Address - Country:US
Practice Address - Phone:615-220-5796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4167235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist