Provider Demographics
NPI:1982239638
Name:SHEPHERD, NICHOLE (MSW)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10305 SW WILSONVILLE RD APT 11
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9545
Mailing Address - Country:US
Mailing Address - Phone:503-421-7500
Mailing Address - Fax:503-239-1262
Practice Address - Street 1:14825 SW FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-2724
Practice Address - Country:US
Practice Address - Phone:503-731-3933
Practice Address - Fax:503-239-1262
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor