Provider Demographics
NPI:1679080873
Name:WILKERSON, MARZELLE (BS, QMHS/CMS)
Entity Type:Individual
Prefix:
First Name:MARZELLE
Middle Name:
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:BS, QMHS/CMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 BAXTER AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-1365
Mailing Address - Country:US
Mailing Address - Phone:513-309-8535
Mailing Address - Fax:
Practice Address - Street 1:2825 BURNET AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2426
Practice Address - Country:US
Practice Address - Phone:513-558-5857
Practice Address - Fax:513-558-5076
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator