Provider Demographics
NPI:1902888423
Name:SHEPHERD, KASEY
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KASEY SHEPHERD
Other - Middle Name:
Other - Last Name:LSCSW LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:200 N BROADWAY AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-2322
Mailing Address - Country:US
Mailing Address - Phone:316-516-2758
Mailing Address - Fax:316-425-7779
Practice Address - Street 1:200 N BROADWAY AVE STE 500
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2322
Practice Address - Country:US
Practice Address - Phone:316-284-6400
Practice Address - Fax:316-284-6491
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical