MEDICARE: DEBRA SHEPPARD PHD PC

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	103G00000X	Clinical Neuropsychologist

General Provider Information

NPI Number	:	1124199831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEBRA SHEPPARD PHD PC

Provider Business Mailing Address
First Line	:	1655 SHILOH RD STE D
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59106-1726
Country	:	US
Telephone Number	:	406-238-6350
Fax Number	:	406-238-6359

Provider Business Practice Location Address
First Line	:	1655 SHILOH RD STE D
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59106-1726
Country	:	US
Telephone Number	:	406-238-6350
Fax Number	:	406-238-6359

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DEBRA SHEPPARD
Credential	:	PHD
Telephone Number	:	406-238-6350

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	10/23/2014

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