Individual
MATTHEW SCOTT QUEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS
Contact information
Practice address
2325 FIELDSTONE DR, AMMON, ID 83401-5852
(208) 419-9810
Mailing address
2325 FIELDSTONE DR, AMMON, ID 83401-5852
(208) 419-9810
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/27/2010
Last updated
09/27/2010
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