Provider Demographics
NPI:1326698770
Name:WILL, ERIN DAWN (QMHS CMS)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:DAWN
Last Name:WILL
Suffix:
Gender:F
Credentials:QMHS CMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 SAINT CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-3147
Mailing Address - Country:US
Mailing Address - Phone:937-610-5880
Mailing Address - Fax:
Practice Address - Street 1:2640 SAINT CHARLES AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45410-3147
Practice Address - Country:US
Practice Address - Phone:937-610-5880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator