Healthcare Provider Details

I. General information

NPI: 1114842325
Provider Name (Legal Business Name): KELLY JEAN SHEPHERD M.A., CCC-SLP
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: YVE JEAN SHEPHERD M.A., CCC-SLP

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 KIMBERLY DR
SAN JOSE CA
95118-1536
US

IV. Provider business mailing address

1290 KIMBERLY DR
SAN JOSE CA
95118-1536
US

V. Phone/Fax

Practice location:
  • Phone: 408-535-6259
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41962
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: