Provider Demographics
NPI:1740452101
Name:SHEPHERD, BARBARA ANNE
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:ANNE
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 1:1555 STEFANIE LN
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-9672
Mailing Address - Country:US
Mailing Address - Phone:815-935-8834
Mailing Address - Fax:815-935-8834
Practice Address - Street 1:1555 STEFANIE LN
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-9672
Practice Address - Country:US
Practice Address - Phone:815-935-8834
Practice Address - Fax:815-935-8834
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist