Provider Demographics
NPI:1073154571
Name:PARK-SALTZMAN, JEESEON (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEESEON
Middle Name:
Last Name:PARK-SALTZMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4929 DIERKER RD STE A
Mailing Address - Street 2:
Mailing Address - City:UPPER ARLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2946
Mailing Address - Country:US
Mailing Address - Phone:614-929-5170
Mailing Address - Fax:614-929-5180
Practice Address - Street 1:4929 DIERKER RD STE A
Practice Address - Street 2:
Practice Address - City:UPPER ARLINGTON
Practice Address - State:OH
Practice Address - Zip Code:43220-2946
Practice Address - Country:US
Practice Address - Phone:614-929-5170
Practice Address - Fax:614-929-5180
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-05
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6981103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling