Provider Demographics
NPI:1457047169
Name:RYOO, HEEJIN (MS)
Entity Type:Individual
Prefix:
First Name:HEEJIN
Middle Name:
Last Name:RYOO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 VIENNA LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5011
Mailing Address - Country:US
Mailing Address - Phone:407-988-6983
Mailing Address - Fax:
Practice Address - Street 1:2914 VIENNA LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5011
Practice Address - Country:US
Practice Address - Phone:407-988-6983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-14
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health