MEDICARE: MR. ROBERT C. SHEPARD LICSW

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	1041C0700X	Clinical Social Worker	LW00006273	WA

General Provider Information

NPI Number	:	1770550774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT C. SHEPARD LICSW

Provider Business Mailing Address
First Line	:	1124 W RIVERSIDE AVE
Second Line	:	LL2
City	:	SPOKANE
State	:	WA
Zip	:	99201-1132
Country	:	US
Telephone Number	:	509-455-8819
Fax Number	:	509-455-8903

Provider Business Practice Location Address
First Line	:	1124 W RIVERSIDE AVE
Second Line	:	LL2
City	:	SPOKANE
State	:	WA
Zip	:	99201-1132
Country	:	US
Telephone Number	:	509-455-8819
Fax Number	:	509-455-8903

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	03/29/2010

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