Doctor Name: | KANESSIA SHEPARD |
NPI Number: | 1992781868 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, CCC-SLP |
License Number: | 05330 |
Business Practice Address: | 9716 Lake Pointe Ct Apt 101 Upper Marlboro, MD - 207744714 |
Business Phone Number: | 2407887089 |
Business Fax Number: | 2407887089 |
Mailing Address: | 9716 Lake Pointe Ct Apt 101, UPPER MARLBORO |
State: | MD |
Postal Code: | 207744714 |
Phone Number: | 2407887089 |
Fax Number: | 2407887089 |
NPI Enumeration Date: | 12/21/2005 |
NPI Last Update Date: | 09/22/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 05330 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |