Provider Demographics
NPI:1043623812
Name:FEISTNER, SHARON
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:FEISTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:FEISTNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PLPC
Mailing Address - Street 1:1531 E SUNSHINE ST
Mailing Address - Street 2:SUITE W-29
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1240
Mailing Address - Country:US
Mailing Address - Phone:417-425-3374
Mailing Address - Fax:
Practice Address - Street 1:1531 E SUNSHINE ST
Practice Address - Street 2:SUITE W-29
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1240
Practice Address - Country:US
Practice Address - Phone:417-425-3374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014016641101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional