Provider Demographics
NPI:1124199831
Name:DEBRA SHEPPARD PHD PC
Entity Type:Organization
Organization Name:DEBRA SHEPPARD PHD PC
Other - Org Name:NORTHERN ROCKIES NEUROPSYCHOLOGY PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:406-238-6350
Mailing Address - Street 1:1655 SHILOH RD STE D
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-1726
Mailing Address - Country:US
Mailing Address - Phone:406-238-6350
Mailing Address - Fax:406-238-6359
Practice Address - Street 1:1655 SHILOH RD STE D
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59106-1726
Practice Address - Country:US
Practice Address - Phone:406-238-6350
Practice Address - Fax:406-238-6359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
011000198Medicare PIN