Provider Demographics
NPI:1568555712
Name:SHEPARD, SHARON S (LSCSW)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:S
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FLEETWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-5429
Mailing Address - Country:US
Mailing Address - Phone:620-221-8965
Mailing Address - Fax:620-221-8995
Practice Address - Street 1:800 MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-2859
Practice Address - Country:US
Practice Address - Phone:620-221-8965
Practice Address - Fax:620-221-8995
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS22671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100098100AMedicaid
KS069641Medicare ID - Type UnspecifiedSSS MEDICARE