Healthcare Provider Details

I. General information

NPI: 1073154571
Provider Name (Legal Business Name): JEESEON PARK-SALTZMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2019
Last Update Date: 06/12/2020
Certification Date: 06/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4929 DIERKER RD STE A
UPPER ARLINGTON OH
43220-2946
US

IV. Provider business mailing address

4929 DIERKER RD STE A
UPPER ARLINGTON OH
43220-2946
US

V. Phone/Fax

Practice location:
  • Phone: 614-929-5170
  • Fax: 614-929-5180
Mailing address:
  • Phone: 614-929-5170
  • Fax: 614-929-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6981
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: