Most Relevant Information
Provider Data
| NPI Number: | 1003329087 |
| Provider Name: | MASON EASTHAM LCDCII |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: | CDCA.169543 |
Most Important Dates
| Enumeration Date: | 11/13/2017 |
| Last Updated: | 11/09/2022 |
Provider Practice Location
700 PARK AVE
IRONTON
OH
456381502
Practice Location Phone/Fax
| Phone: | 7405321613 |
| Fax: | 7405321715 |
Provider Mailing Location
PO BOX 108
IRONTON
OH
456380108
Provider Mailing Phone/Fax
| Phone: | 7405321613 |
| Fax: | 7405321715 |