MEDICARE: MONIQUE AUSTIN

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1720945074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUE AUSTIN

Provider Business Mailing Address
First Line	:	2021 BRUSSELS ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43613-4520
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2021 BRUSSELS ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43613-4520
Country	:	US
Telephone Number	:	419-206-9963
Fax Number	:

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

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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