Provider Demographics
NPI:1437371523
Name:SHEPARD, BRANDI R (CCC-A, F-AAA)
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:R
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:CCC-A, F-AAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3409
Mailing Address - Country:US
Mailing Address - Phone:307-527-7501
Mailing Address - Fax:307-578-2492
Practice Address - Street 1:424 YELLOWSTONE AVE STE 310
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414
Practice Address - Country:US
Practice Address - Phone:307-578-2976
Practice Address - Fax:307-578-2941
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYA1006231H00000X
COAUD 424231H00000X
WYA-1006231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist