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General NPI Number Information
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NPI Number | 1053298307
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Entity Type | Individual
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Provider Name | TARA SHEPPARD LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/19/2025
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 415 WASHINGTON ST STE 216S
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City | WAUKEGAN
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State | IL
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Zip | 60085-5564
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Country | US
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Telephone | 773-991-3983
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Fax |
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Provider Business Mailing Address
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Address Line | 38 BURNETT AVE
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City | LAKE VILLA
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State | IL
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Zip | 60046-9004
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Country | US
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Telephone | 847-912-3573
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149019428
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License Number State | IL
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