Provider Demographics
NPI:1689147431
Name:BECKER, JOANNA CHRISTINE (CLC)
Entity Type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:CHRISTINE
Last Name:BECKER
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24636 WOOLLY MAMMOTH TER UNIT 303
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-3205
Mailing Address - Country:US
Mailing Address - Phone:571-510-2794
Mailing Address - Fax:
Practice Address - Street 1:24636 WOOLLY MAMMOTH TER UNIT 303
Practice Address - Street 2:
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-3205
Practice Address - Country:US
Practice Address - Phone:571-510-2794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA283616174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN