Healthcare Provider Details

I. General information

NPI: 1396216511
Provider Name (Legal Business Name): HEATHER SHEPPARD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ANSBACH HEALTH CLINIC
APO AE
09250
US

IV. Provider business mailing address

PSC 454 BOX 1213
APO AE
09250-0013
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-3726
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09925451
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28245
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: