Provider Demographics
NPI:1033141809
Name:SALZMAN, KENNETH L (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:L
Last Name:SALZMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 W SAINT JOSEPH ST STE B400A
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-5605
Mailing Address - Country:US
Mailing Address - Phone:517-482-0033
Mailing Address - Fax:517-321-3777
Practice Address - Street 1:3815 W SAINT JOSEPH ST STE B400A
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-5605
Practice Address - Country:US
Practice Address - Phone:517-482-0033
Practice Address - Fax:517-321-3777
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003959103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI035891OtherVALUEOPTIONS MH
MI680C346140OtherBCBS OF MICHIGAN
MI1009259OtherMCLAREN HEALTH PLAN
MI0C32059OtherBCBSM PROVIDER IDENTIFICATION NUMBER
MI1009259OtherMCLAREN HEALTH PLAN