Provider Demographics
NPI:1528556768
Name:COLEMAN, SUSAN B (QMHS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:B
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 1:33 W 1ST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-1243
Mailing Address - Country:US
Mailing Address - Phone:937-262-4641
Mailing Address - Fax:
Practice Address - Street 1:33 W 1ST ST STE 100
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-1243
Practice Address - Country:US
Practice Address - Phone:937-262-4641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator