Provider Demographics
NPI:1790901221
Name:SHEPHERD, MARINA ALLEN
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:ALLEN
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 PITTS FRK
Mailing Address - Street 2:
Mailing Address - City:DAVID
Mailing Address - State:KY
Mailing Address - Zip Code:41616-9034
Mailing Address - Country:US
Mailing Address - Phone:606-886-7842
Mailing Address - Fax:
Practice Address - Street 1:366 KY ROUTE 680
Practice Address - Street 2:
Practice Address - City:MC DOWELL
Practice Address - State:KY
Practice Address - Zip Code:41647-6012
Practice Address - Country:US
Practice Address - Phone:606-377-6640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1448235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist