Provider Demographics
NPI:1043919665
Name:COLEMAN, JASHALA (QMHS)
Entity Type:Individual
Prefix:
First Name:JASHALA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 W SOUTH BOUNDARY ST STE 6
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5101
Mailing Address - Country:US
Mailing Address - Phone:440-225-8104
Mailing Address - Fax:
Practice Address - Street 1:118 W SOUTH BOUNDARY ST STE 6
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5101
Practice Address - Country:US
Practice Address - Phone:440-225-8104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator