Provider Demographics
NPI:1114425881
Name:SHEPPARD, KRISTINA A (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:A
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2538 NW HILLCREST LOOP
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-5477
Mailing Address - Country:US
Mailing Address - Phone:971-241-8745
Mailing Address - Fax:
Practice Address - Street 1:2538 NW HILLCREST LOOP
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-5477
Practice Address - Country:US
Practice Address - Phone:971-241-8745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR011746235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist