Active NPI
Kathleen Shepherd
- Clinical Social Worker
- Saint Maries, ID
National Provider Identifier
1306000575
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW-28880
- Practice address
- 622 W College Ave Ste 2
Saint Maries, ID 83861-1822 - Phone
- (205) 245-4363
- Fax
- (208) 245-4349
- NPI assigned
- Jul 16, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW-28880 | ID | Primary |
Addresses
Primary practice location
622 W College Ave Ste 2
Saint Maries, ID 83861-1822
Mailing address
622 W College Ave Ste 2
Saint Maries, ID 83861-1822
Phone (205) 245-4363
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW-28880 | ID | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216166400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424908800000",
"number": "1306000575",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "622 W COLLEGE AVE STE 2",
"city": "SAINT MARIES",
"state": "ID",
"postal_code": "838611822",
"telephone_number": "205-245-4363",
"fax_number": "208-245-4349"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "622 W COLLEGE AVE STE 2",
"city": "SAINT MARIES",
"state": "ID",
"postal_code": "838611822",
"telephone_number": "205-245-4363",
"fax_number": "208-245-4349"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEPHERD",
"first_name": "KATHLEEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-07-16",
"last_updated": "2015-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ID",
"license": "LCSW-28880",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Maries, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.