MEDICARE: QUEEN ESTHER MCGRUDER RSPS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist	5138-0125	TX

General Provider Information

NPI Number	:	1811848500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUEEN ESTHER MCGRUDER RSPS

Provider Business Mailing Address
First Line	:	1839 JACQUELYN DR APT 318
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-2532
Country	:	US
Telephone Number	:	979-739-8676
Fax Number	:

Provider Business Practice Location Address
First Line	:	1839 JACQUELYN DR APT 318
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-2532
Country	:	US
Telephone Number	:	979-739-8676
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2026
Last Update Date	:	02/07/2026

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