Provider Demographics
NPI:1841754801
Name:STANTON, KATIE (QMHS)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:STANTON
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 1:695 SOUTH ST STE 6
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-1474
Mailing Address - Country:US
Mailing Address - Phone:440-286-1553
Mailing Address - Fax:440-286-1318
Practice Address - Street 1:695 SOUTH ST STE 6
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1474
Practice Address - Country:US
Practice Address - Phone:440-286-1553
Practice Address - Fax:440-286-1318
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator