MEDICARE: NICHOLE SHEPHERD MSW

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
1	101Y00000X	Counselor
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1982239638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE SHEPHERD MSW

Provider Business Mailing Address
First Line	:	10305 SW WILSONVILLE RD APT 11
Second Line	:
City	:	WILSONVILLE
State	:	OR
Zip	:	97070-9545
Country	:	US
Telephone Number	:	503-421-7500
Fax Number	:	503-239-1262

Provider Business Practice Location Address
First Line	:	14825 SW FARMINGTON RD
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97007-2724
Country	:	US
Telephone Number	:	503-731-3933
Fax Number	:	503-239-1262

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2020
Last Update Date	:	03/03/2020

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Directions to “ NICHOLE SHEPHERD MSW” Practice Location

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