Provider Demographics
NPI:1740782838
Name:SHEPHERD, JENNIFER A (LPCC, LADC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-4407
Mailing Address - Country:US
Mailing Address - Phone:612-238-6525
Mailing Address - Fax:
Practice Address - Street 1:3231 1ST AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-4407
Practice Address - Country:US
Practice Address - Phone:612-238-6525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305275101YA0400X
MNCC01966101YP2500X
FLMH14984101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH14984OtherFLORIDA DEPARTMENT OF HEALTH