Provider Demographics
NPI:1326168220
Name:KORBLY SHEPARD, MARY ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:
Last Name:KORBLY SHEPARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 W MINER ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1386
Mailing Address - Country:US
Mailing Address - Phone:317-690-0673
Mailing Address - Fax:847-952-1374
Practice Address - Street 1:366 W MINER ST APT 1A
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1386
Practice Address - Country:US
Practice Address - Phone:317-690-0673
Practice Address - Fax:847-952-1374
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490114091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical