Provider Demographics
NPI:1477194173
Name:OH, ISABELLE (PSYD)
Entity Type:Individual
Prefix:
First Name:ISABELLE
Middle Name:
Last Name:OH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 N 25TH ST APT 403
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-5322
Mailing Address - Country:US
Mailing Address - Phone:812-360-8409
Mailing Address - Fax:
Practice Address - Street 1:1220 DIVISION AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-1321
Practice Address - Country:US
Practice Address - Phone:253-403-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPSYC.PY.60985192103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent