Provider Demographics
NPI:1689233991
Name:SHEPHERD, EMILY ELIZABETH (M ED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ELIZABETH
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:M ED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 YOUNGS MILL RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30145-1526
Mailing Address - Country:US
Mailing Address - Phone:706-936-6682
Mailing Address - Fax:
Practice Address - Street 1:283 RED HAWK WAY # 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-1149
Practice Address - Country:US
Practice Address - Phone:561-801-3148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP010644235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist