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Individual

KENT A HERSHBERGER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
HSPP

Contact information

Practice address
150 W ANGELA BLVD, SOUTH BEND, IN 46617-1101
(574) 220-4968
Mailing address
150 W ANGELA BLVD, SOUTH BEND, IN 46617-1101
(574) 220-4968

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20041322A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000202186
ANTHEM
IN
05
200264420
IN
05
200288970
IN
Enumeration date
06/15/2006
Last updated
06/20/2011
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