Provider Demographics
NPI:1134098627
Name:PRIDE & JOY GENDER AFFIRMING CARE CLINIC PLLC
Entity type:Organization
Organization Name:PRIDE & JOY GENDER AFFIRMING CARE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANTI
Authorized Official - Middle Name:
Authorized Official - Last Name:HERZOG
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:253-881-7743
Mailing Address - Street 1:2103 HARRISON AVE NW STE 2
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-2607
Mailing Address - Country:US
Mailing Address - Phone:253-881-7743
Mailing Address - Fax:253-881-7158
Practice Address - Street 1:1326 22ND AVE SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-3014
Practice Address - Country:US
Practice Address - Phone:253-881-7743
Practice Address - Fax:253-881-7158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-03
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service