MEDICARE: ANNA QUEEN LPCC

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	172V00000X	Community Health Worker
2	101Y00000X	Counselor	E.2606117	OH
3	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1861139107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA QUEEN LPCC

Provider Business Mailing Address
First Line	:	6525 MEADOWCROFT LN
Second Line	:
City	:	MAUMEE
State	:	OH
Zip	:	43537-1128
Country	:	US
Telephone Number	:	419-552-8293
Fax Number	:

Provider Business Practice Location Address
First Line	:	1294 CONANT ST STE 401B
Second Line	:
City	:	MAUMEE
State	:	OH
Zip	:	43537-1676
Country	:	US
Telephone Number	:	419-552-8293
Fax Number	:

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

Provider Enumeration Date	:	05/18/2022
Last Update Date	:	04/01/2026

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Directions to “ ANNA QUEEN LPCC” Practice Location

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