Provider Demographics
NPI:1417468497
Name:SHEPARD, BOBBETTE SPRAGUE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BOBBETTE
Middle Name:SPRAGUE
Last Name: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 1:535 W 300 N
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-2017
Mailing Address - Country:US
Mailing Address - Phone:435-201-1735
Mailing Address - Fax:435-893-0357
Practice Address - Street 1:81 E 900 N
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1845
Practice Address - Country:US
Practice Address - Phone:435-890-0359
Practice Address - Fax:435-893-0357
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT116040-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical