Provider Demographics
NPI:1427550680
Name:SAYLOR, LYDIA KATE (QMHSIII)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:KATE
Last Name:SAYLOR
Suffix:
Gender:F
Credentials:QMHSIII
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:KATE
Other - Last Name:STOCKERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:QMHSIII, CDCAI
Mailing Address - Street 1:624 MARKET AVE N
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44702-1017
Mailing Address - Country:US
Mailing Address - Phone:330-479-1912
Mailing Address - Fax:
Practice Address - Street 1:624 MARKET AVE N
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702
Practice Address - Country:US
Practice Address - Phone:330-479-1912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHCDCA.166609101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator