Provider Demographics
NPI:1417299777
Name:CLOSSON, SHANNON RENEA (MS, QMHS)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:RENEA
Last Name:CLOSSON
Suffix:
Gender:F
Credentials:MS, QMHS
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:RENEA
Other - Last Name:MCCREARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, QMHS
Mailing Address - Street 1:2208 READING RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-1420
Mailing Address - Country:US
Mailing Address - Phone:513-651-4142
Mailing Address - Fax:
Practice Address - Street 1:2208 READING RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-1420
Practice Address - Country:US
Practice Address - Phone:513-651-4142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0280974Medicaid