Provider Demographics
NPI:1821208885
Name:SHEPARD, JULIE KATHLEEN (MED, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:KATHLEEN
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:MED, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 82546
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30608-2546
Mailing Address - Country:US
Mailing Address - Phone:706-424-1052
Mailing Address - Fax:
Practice Address - Street 1:212 CARRINGTON DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-7063
Practice Address - Country:US
Practice Address - Phone:706-310-7115
Practice Address - Fax:706-310-7116
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003655231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist