Provider Demographics
NPI:1811468523
Name:HERSHBERGER, JOY JENEE (CLC)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:JENEE
Last Name:HERSHBERGER
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 1:1480 WOODSTONE DR STE 112
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-6872
Mailing Address - Country:US
Mailing Address - Phone:636-699-2839
Mailing Address - Fax:
Practice Address - Street 1:1480 WOODSTONE DR STE 112
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-6872
Practice Address - Country:US
Practice Address - Phone:636-699-2839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOALPP-307064174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPP-307064OtherTHE ACADEMY OF LACTATION POLICY AND PRACTICE