Provider Demographics
NPI:1083213631
Name:ROBERT J. SHEPPARD PHD PLLC
Entity Type:Organization
Organization Name:ROBERT J. SHEPPARD PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:269-303-6296
Mailing Address - Street 1:8339 BROOKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-5207
Mailing Address - Country:US
Mailing Address - Phone:269-303-6296
Mailing Address - Fax:
Practice Address - Street 1:8339 BROOKWOOD DR
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-5207
Practice Address - Country:US
Practice Address - Phone:269-303-6296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-23
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty