Individual
SHANNON RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHS/CDCA
Contact information
Practice address
5244 W 2ND ST, DAYTON, OH 45417-9044
(937) 369-9916
Mailing address
5244 W 2ND ST, DAYTON, OH 45417-9044
(937) 369-9916
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
CDCA.165915
OH
3747P1801X
Personal Care Attendant
Primary
—
OH
Other
Enumeration date
10/08/2018
Last updated
07/25/2024
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