Provider Demographics
NPI:1740346006
Name:HERSHBERGER, MARY A (LPC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:A
Last Name:HERSHBERGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10500 N PORT WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5585
Mailing Address - Country:US
Mailing Address - Phone:262-240-0427
Mailing Address - Fax:262-240-0429
Practice Address - Street 1:10500 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5585
Practice Address - Country:US
Practice Address - Phone:262-240-0427
Practice Address - Fax:262-240-0429
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2055-125103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39225300Medicaid