Provider Demographics
NPI:1952871279
Name:INGRAM, AISHA L
Entity Type:Individual
Prefix:MRS
First Name:AISHA
Middle Name:L
Last Name:INGRAM
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:AISHA
Other - Middle Name:L
Other - Last Name:WADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2642 PANCOAST AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-7815
Mailing Address - Country:US
Mailing Address - Phone:937-902-6784
Mailing Address - Fax:
Practice Address - Street 1:4968 GLENWAY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-3902
Practice Address - Country:US
Practice Address - Phone:513-853-6575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator