MEDICARE: JERRHONDA ANNE STALLWORTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1871258632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRHONDA ANNE STALLWORTH

Provider Business Mailing Address
First Line	:	900 ADAMS ST APT 2
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-1675
Country	:	US
Telephone Number	:	513-226-0230
Fax Number	:

Provider Business Practice Location Address
First Line	:	1286 SIMMONS AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-2327
Country	:	US
Telephone Number	:	513-226-0230
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2021
Last Update Date	:	11/05/2021

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