Provider Demographics
NPI:1467043141
Name:VANDYKE, TONYEA LYNN (QMHS)
Entity Type:Individual
Prefix:
First Name:TONYEA
Middle Name:LYNN
Last Name:VANDYKE
Suffix:
Gender:F
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43968-1411
Mailing Address - Country:US
Mailing Address - Phone:330-303-9572
Mailing Address - Fax:
Practice Address - Street 1:321 W 5TH ST
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-2849
Practice Address - Country:US
Practice Address - Phone:330-385-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator