Healthcare Provider Details

I. General information

NPI: 1063387025
Provider Name (Legal Business Name): KYAH PATTERSON QMHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 BERLIN RD
HURON OH
44839-1909
US

IV. Provider business mailing address

619 BERLIN RD
HURON OH
44839-1909
US

V. Phone/Fax

Practice location:
  • Phone: 419-504-1485
  • Fax:
Mailing address:
  • Phone: 419-504-1485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2613619
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: