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NPI Code Detail

MEDICARE: MR. JOSEPH SHEPHERD IV MSW

MEDICARE: MR. JOSEPH SHEPHERD IV MSW
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
1104100000XSocial Worker33011069AIN
2104100000XSocial Worker257319KY
31041C0700XClinical Social Worker34011640AIN

General Provider Information

NPI Number : 1336858133
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOSEPH SHEPHERD IV MSW
Provider Business Mailing Address
First Line : 5534 SAINT JOE RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46835-3328
Country : US
Telephone Number : 502-528-4220
Fax Number :
Provider Business Practice Location Address
First Line : 5534 SAINT JOE RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46835-3328
Country : US
Telephone Number : 502-528-4220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2022
Last Update Date : 05/22/2026

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