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NPI Code Detail

MEDICARE: MONICA ROSEANN SHEPPARD

MEDICARE:   MONICA ROSEANN SHEPPARD
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1235527003
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONICA ROSEANN SHEPPARD
Provider Business Mailing Address
First Line : 5233 W RACE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60644-1661
Country : US
Telephone Number : 312-731-5235
Fax Number :
Provider Business Practice Location Address
First Line : 2248 S MICHIGAN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60616-5258
Country : US
Telephone Number : 312-842-4498
Fax Number : 312-842-6545
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2015
Last Update Date : 01/19/2016

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Directions to “ MONICA ROSEANN SHEPPARD ” Practice Location

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