MEDICARE: LAUREL C SHEPPICK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1013473776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREL C SHEPPICK

Provider Business Mailing Address
First Line	:	614 SIDER DR
Second Line	:
City	:	NORTH SALT LAKE
State	:	UT
Zip	:	84054-3170
Country	:	US
Telephone Number	:	801-628-3285
Fax Number	:

Provider Business Practice Location Address
First Line	:	614 SIDER DR
Second Line	:
City	:	NORTH SALT LAKE
State	:	UT
Zip	:	84054-3170
Country	:	US
Telephone Number	:	801-628-3285
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2019
Last Update Date	:	07/19/2019

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Directions to “ LAUREL C SHEPPICK ” Practice Location

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