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NPI Code Detail

MEDICARE: KATHLEEN SHEPHERD

MEDICARE: KATHLEEN SHEPHERD
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
11041C0700XClinical Social WorkerLCSW-28880ID

General Provider Information

NPI Number : 1306000575
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN SHEPHERD
Provider Business Mailing Address
First Line : 622 W COLLEGE AVE STE 2
Second Line :
City : SAINT MARIES
State : ID
Zip : 83861-1822
Country : US
Telephone Number : 205-245-4363
Fax Number : 208-245-4349
Provider Business Practice Location Address
First Line : 622 W COLLEGE AVE STE 2
Second Line :
City : SAINT MARIES
State : ID
Zip : 83861-1822
Country : US
Telephone Number : 205-245-4363
Fax Number : 208-245-4349
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2008
Last Update Date : 02/26/2015

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Directions to “ KATHLEEN SHEPHERD ” Practice Location

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