Provider Demographics
NPI:1548452998
Name:SHEPARD, KATHLEEN REBEKAH (SLP/CCC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:REBEKAH
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:SLP/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 NW 17TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-3564
Mailing Address - Country:US
Mailing Address - Phone:352-256-5072
Mailing Address - Fax:
Practice Address - Street 1:4011 NW 17TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3564
Practice Address - Country:US
Practice Address - Phone:352-256-5072
Practice Address - Fax:877-904-8450
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9491235Z00000X
NC30002354235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist