Healthcare Provider Details

I. General information

NPI: 1679080873
Provider Name (Legal Business Name): MARZELLE WILKERSON BS, QMHS/CMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 BURNET AVE
CINCINNATI OH
45219-2426
US

IV. Provider business mailing address

257 BAXTER AVE APT 1
CINCINNATI OH
45220-1365
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-5857
  • Fax: 513-558-5076
Mailing address:
  • Phone: 513-309-8535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: