Healthcare Provider Details

I. General information

NPI: 1306335393
Provider Name (Legal Business Name): HEATHER RENEE DILLON CRST, QMHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 10/30/2024
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 COUNTY ROAD 2000
JEROMESVILLE OH
44840-9758
US

IV. Provider business mailing address

304 COUNTY ROAD 2000
JEROMESVILLE OH
44840-9758
US

V. Phone/Fax

Practice location:
  • Phone: 419-289-4825
  • Fax: 419-289-4826
Mailing address:
  • Phone: 419-289-4825
  • Fax: 419-289-4826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: