Healthcare Provider Details

I. General information

NPI: 1811804958
Provider Name (Legal Business Name): HEATHER JUSTEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W STATE ST STE A
FREMONT OH
43420-2580
US

IV. Provider business mailing address

500 W STATE ST STE A
FREMONT OH
43420-2580
US

V. Phone/Fax

Practice location:
  • Phone: 419-332-6454
  • Fax:
Mailing address:
  • Phone: 419-332-6454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLSP.00622
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: