Provider Demographics
NPI:1215510292
Name:WESTBERG, JOEL ROBERT (MS,RD,LD)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:ROBERT
Last Name:WESTBERG
Suffix:
Gender:M
Credentials:MS,RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SUTTON HILL CT
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-5719
Mailing Address - Country:US
Mailing Address - Phone:615-525-8217
Mailing Address - Fax:
Practice Address - Street 1:255 OHIO AVE NW
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-1342
Practice Address - Country:US
Practice Address - Phone:615-525-8217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09293133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered