Provider Demographics
NPI:1982282620
Name:AUSTIN-OWENS, IESHA (QMHS)
Entity Type:Individual
Prefix:
First Name:IESHA
Middle Name:
Last Name:AUSTIN-OWENS
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 1:5600 MONROE ST STE B207
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2728
Mailing Address - Country:US
Mailing Address - Phone:567-698-8200
Mailing Address - Fax:
Practice Address - Street 1:5600 MONROE ST STE B207
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2728
Practice Address - Country:US
Practice Address - Phone:567-698-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator