Provider Demographics
NPI:1114713393
Name:MACQUEEN, MANDI LEIGH
Entity type:Individual
Prefix:
First Name:MANDI
Middle Name:LEIGH
Last Name:MACQUEEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:MANDI
Other - Middle Name:LEIGH
Other - Last Name:HUNSUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2909 COWLEY WAY UNIT F
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6816
Mailing Address - Country:US
Mailing Address - Phone:913-687-8497
Mailing Address - Fax:
Practice Address - Street 1:2909 COWLEY WAY UNIT F
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6816
Practice Address - Country:US
Practice Address - Phone:913-687-8497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician