Provider Demographics
NPI:1265004592
Name:SHEPP, ISABELLE R
Entity Type:Individual
Prefix:
First Name:ISABELLE
Middle Name:R
Last Name:SHEPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-4721
Mailing Address - Country:US
Mailing Address - Phone:304-363-7323
Mailing Address - Fax:304-366-2483
Practice Address - Street 1:239 COURT AVE
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-2099
Practice Address - Country:US
Practice Address - Phone:304-363-7323
Practice Address - Fax:304-366-2483
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVA1H144400005103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool