Provider Demographics
NPI:1457143364
Name:BLACKMON, MARQITA
Entity type:Individual
Prefix:
First Name:MARQITA
Middle Name:
Last Name:BLACKMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 TRIMBLE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45207-1647
Mailing Address - Country:US
Mailing Address - Phone:513-526-6446
Mailing Address - Fax:
Practice Address - Street 1:205 EHRMAN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-1313
Practice Address - Country:US
Practice Address - Phone:513-376-7418
Practice Address - Fax:513-221-2791
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator