Healthcare Provider Details

I. General information

NPI: 1447431663
Provider Name (Legal Business Name): JOHN EDWARD QUEENER JR. PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1293 COPLEY RD
AKRON OH
44320-2766
US

IV. Provider business mailing address

1293 COPLEY RD
AKRON OH
44320-2766
US

V. Phone/Fax

Practice location:
  • Phone: 330-374-1199
  • Fax: 330-374-0151
Mailing address:
  • Phone: 330-374-1199
  • Fax: 330-374-0151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number5209
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: