Provider Demographics
NPI:1992132971
Name:SHEPHERD, AMBERLEE ALISSA
Entity type:Individual
Prefix:MRS
First Name:AMBERLEE
Middle Name:ALISSA
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1484 N 1600 E
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2910
Mailing Address - Country:US
Mailing Address - Phone:435-881-9170
Mailing Address - Fax:
Practice Address - Street 1:186 E 1800 N
Practice Address - Street 2:
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2019
Practice Address - Country:US
Practice Address - Phone:435-213-3062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program