Provider Demographics
NPI:1942294541
Name:VANKLEY, PATRICIA A (PH D)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:A
Last Name:VANKLEY
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:A
Other - Last Name:VAN KLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PH D
Mailing Address - Street 1:975 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5228
Mailing Address - Country:US
Mailing Address - Phone:419-874-8257
Mailing Address - Fax:419-874-9960
Practice Address - Street 1:975 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5228
Practice Address - Country:US
Practice Address - Phone:419-874-8257
Practice Address - Fax:419-874-9960
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4836103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCP15481Medicare PIN