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General NPI Number Information
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NPI Number | 1902396591
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Entity Type | Individual
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Provider Name | AUDREY DAWN SHEPPARD PLPC
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Gender | Female
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 05/18/2018
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Provider Practice Location Address
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Address Line | 89 MCCRORY DR
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City | CAMDENTON
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State | MO
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Zip | 65020
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Country | US
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Telephone | 573-525-7071
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Fax | 573-525-7072
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Provider Business Mailing Address
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Address Line | 252 LONE WOLF DR
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City | GRAVOIS MILLS
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State | MO
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Zip | 65037-6631
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Country | US
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Telephone | 573-525-7071
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Fax | 573-525-7072
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2018015969
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License Number State | MO
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