Healthcare Provider Details

I. General information

NPI: 1831858406
Provider Name (Legal Business Name): MRS. JANETTE SHEPPARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 W HERON ST
ABERDEEN WA
98520-6022
US

IV. Provider business mailing address

5115 NE 94TH AVE STE D
VANCOUVER WA
98662-6180
US

V. Phone/Fax

Practice location:
  • Phone: 564-544-1950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSA61183351
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC61337386
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: