Provider Demographics
NPI:1023480068
Name:QUEENER, ANNA-MARIA EVE (EDS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ANNA-MARIA
Middle Name:EVE
Last Name:QUEENER
Suffix:
Gender:F
Credentials:EDS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 BLACK BASS RD
Mailing Address - Street 2:
Mailing Address - City:COHUTTA
Mailing Address - State:GA
Mailing Address - Zip Code:30710-7809
Mailing Address - Country:US
Mailing Address - Phone:706-508-8129
Mailing Address - Fax:
Practice Address - Street 1:932 BLACK BASS RD
Practice Address - Street 2:
Practice Address - City:COHUTTA
Practice Address - State:GA
Practice Address - Zip Code:30710-7809
Practice Address - Country:US
Practice Address - Phone:706-508-8129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008808235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist