Provider Demographics
NPI:1053437269
Name:MCQUEEN, TERI BENGE (SLP)
Entity type:Individual
Prefix:MRS
First Name:TERI
Middle Name:BENGE
Last Name:MCQUEEN
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 1:4816 N KY 501
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:KY
Mailing Address - Zip Code:40442-8937
Mailing Address - Country:US
Mailing Address - Phone:859-583-0060
Mailing Address - Fax:606-379-5561
Practice Address - Street 1:4816 N KY 501
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:KY
Practice Address - Zip Code:40442-8937
Practice Address - Country:US
Practice Address - Phone:859-583-0060
Practice Address - Fax:606-379-5561
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2015235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist