Kenneth Galen Queen, MED., LCPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

180.006438 Issued in IL

Practice address

3020 W. Willow Knolls Dr.
Peoria, IL 61614

Phone

(309) 681-5652

Fax

(309) 681-5658

NPI assigned

Feb 8, 2010

Last updated

Feb 8, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1265587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265587200000",
    "number": "1437481009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 W. WILLOW KNOLLS DR.",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61614",
            "telephone_number": "309-681-5652",
            "fax_number": "309-681-5658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3020 W. WILLOW KNOLLS DR.",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61614",
            "telephone_number": "309-681-5652",
            "fax_number": "309-681-5658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUEEN",
        "first_name": "KENNETH",
        "middle_name": "GALEN",
        "name_prefix": "Mr.",
        "credential": "MED., LCPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-02-08",
        "last_updated": "2010-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180.006438",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Harrison C Putman III, MD
• Svyatoslav Puyat
• Precious Pyles
• Paula Jane Quaka
• Jenna Quartier, MSW, LCSW
• Kristen Querciagrossa, RPH
• Lexi Sue Quesse
• Megan D Quick, COTA/L
• Robert M Quilleash
• Melissa Anne Quin

• Mental Health Counselor in Peoria, IL
• Providers in Peoria, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.