Provider Demographics
NPI:1710160650
Name:SALSTROM, SEOKA A (PHD)
Entity Type:Individual
Prefix:DR
First Name:SEOKA
Middle Name:A
Last Name:SALSTROM
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 1:45 LYME RD
Mailing Address - Street 2:SUITE 305A
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755
Mailing Address - Country:US
Mailing Address - Phone:603-755-6535
Mailing Address - Fax:603-389-9331
Practice Address - Street 1:45 LYME RD
Practice Address - Street 2:SUITE 305A
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755
Practice Address - Country:US
Practice Address - Phone:603-755-6535
Practice Address - Fax:603-389-9331
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1370103TC0700X
VT048.0110832103TC0700X
IL071.007362103TC0700X
IL071-007362103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL071.007362OtherSTATE LICENSE