Provider Demographics
NPI:1790853265
Name:MCQUEEN, ELIZABETH (BA)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:MCQUEEN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 E WERNSING AVE
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-4028
Mailing Address - Country:US
Mailing Address - Phone:217-234-6405
Mailing Address - Fax:217-258-6136
Practice Address - Street 1:1300 CHARLESTON AVE
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4016
Practice Address - Country:US
Practice Address - Phone:217-234-6405
Practice Address - Fax:217-258-6136
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health