Provider Demographics
NPI:1497393938
Name:HUETHER, BRIANNA (QMHS, CSM)
Entity Type:Individual
Prefix:MISS
First Name:BRIANNA
Middle Name:
Last Name:HUETHER
Suffix:
Gender:F
Credentials:QMHS, CSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2894 COUNTY ROAD 213
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:OH
Mailing Address - Zip Code:43410-9571
Mailing Address - Country:US
Mailing Address - Phone:419-765-0505
Mailing Address - Fax:
Practice Address - Street 1:675 BARTSON RD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-9672
Practice Address - Country:US
Practice Address - Phone:419-332-5524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator