Provider Demographics
NPI:1790977379
Name:SHEPPARD, LAURA JANINE (MS, PSYD, LPC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:JANINE
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:MS, PSYD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 N. MAIN STREET
Mailing Address - Street 2:SUITE 201-C
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7429
Mailing Address - Country:US
Mailing Address - Phone:503-423-7951
Mailing Address - Fax:
Practice Address - Street 1:320 N. MAIN
Practice Address - Street 2:SUITE 201
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7429
Practice Address - Country:US
Practice Address - Phone:503-423-7951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2132101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional