Provider Demographics
NPI:1710495270
Name:LOCKARD, EMILY MAE (BA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MAE
Last Name:LOCKARD
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:MAE
Other - Last Name:WYRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4970 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4970 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1018
Practice Address - Country:US
Practice Address - Phone:330-759-8237
Practice Address - Fax:330-759-9532
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator