Healthcare Provider Details

I. General information

NPI: 1861324352
Provider Name (Legal Business Name): KAYLEIGH ANNE MCQUEEN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 S WALL ST
CALHOUN GA
30701-3062
US

IV. Provider business mailing address

1431 CAPITAL AVE STE 123
WATKINSVILLE GA
30677-1883
US

V. Phone/Fax

Practice location:
  • Phone: 770-207-6390
  • Fax:
Mailing address:
  • Phone: 770-207-6390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP014133
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: