Tyteisha Queen, MSW, LSWAIC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SC61686961 Issued in WA

Practice address

12039 Minnie Rose LN NE
Bainbridge Island, WA 98110-7503

Phone

(206) 595-6223

NPI assigned

Jul 24, 2025

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Iris Queen Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1753315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753315200000",
    "number": "1790667111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12039 MINNIE ROSE LN NE",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "981107503",
            "telephone_number": "206-595-6223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12039 MINNIE ROSE LN NE",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "981107503",
            "telephone_number": "206-595-6223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUEEN",
        "first_name": "TYTEISHA",
        "credential": "MSW, LSWAIC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-24",
        "last_updated": "2025-07-24",
        "certification_date": "2025-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "SC61686961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IRIS",
            "last_name": "QUEEN",
            "credential": "MSW, LSWAIC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Clinical Social Worker in Bainbridge Island, WA
• Providers in Bainbridge Island, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2025; 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.