Provider Demographics
NPI:1013085364
Name:REPPEL, SHELLEY LENEE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:LENEE
Last Name:REPPEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 LAKE OTIS PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5209
Mailing Address - Country:US
Mailing Address - Phone:907-569-6906
Mailing Address - Fax:907-569-6908
Practice Address - Street 1:3820 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5209
Practice Address - Country:US
Practice Address - Phone:907-569-6906
Practice Address - Fax:907-569-6908
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK152316Medicare ID - Type Unspecified