Provider Demographics
NPI:1528540184
Name:WATERS, SUZANNE CAROL
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:CAROL
Last Name:WATERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 SYCAMORE ST STE 400
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-1318
Mailing Address - Country:US
Mailing Address - Phone:513-352-1342
Mailing Address - Fax:513-352-1345
Practice Address - Street 1:911 SYCAMORE ST STE 400
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-1318
Practice Address - Country:US
Practice Address - Phone:513-352-1342
Practice Address - Fax:513-352-1345
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator