Healthcare Provider Details

I. General information

NPI: 1700714052
Provider Name (Legal Business Name): JARED CHRISTOPHER QUEEN M.S., CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44322 HARDWOOD AVE
LANCASTER CA
93534
US

IV. Provider business mailing address

3378 POPLAR ST
ROSAMOND CA
93560-6853
US

V. Phone/Fax

Practice location:
  • Phone: 661-948-4661
  • Fax:
Mailing address:
  • Phone: 661-341-1015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number38995
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: