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NPI Code Detail

MEDICARE: MOLLY ELIZABETH SHEPHERD MSW, LISW

MEDICARE: MOLLY ELIZABETH SHEPHERD MSW, LISW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerI10252OH

General Provider Information

NPI Number : 1952488249
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLY ELIZABETH SHEPHERD MSW, LISW
Provider Business Mailing Address
First Line : 314 N JEFFERSON ST
Second Line :
City : VAN WERT
State : OH
Zip : 45891-1145
Country : US
Telephone Number : 419-203-0591
Fax Number : 419-238-1356
Provider Business Practice Location Address
First Line : 1158 WESTWOOD DR
Second Line :
City : VAN WERT
State : OH
Zip : 45891-2449
Country : US
Telephone Number : 419-238-3434
Fax Number : 419-238-1356
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 07/09/2007

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