Provider Demographics
NPI:1932622925
Name:SHEPPARD, LISA BUTCHER (M ED, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:BUTCHER
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:M ED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CROSSWINDS DR APT B2
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33413-2068
Mailing Address - Country:US
Mailing Address - Phone:561-389-8757
Mailing Address - Fax:
Practice Address - Street 1:600 CROSSWINDS DR APT B2
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33413-2068
Practice Address - Country:US
Practice Address - Phone:561-389-8757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2023-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA4200OtherSPEECH LANGUAGE PATHOLOGIST LICENSE