| Robert J. Sheppard Phd Pllc | |
|
8339 Brookwood Dr Portage MI 49024-5207 | |
| (269) 303-6296 | |
| Not Available |
| Full Name | Robert J. Sheppard Phd Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 8339 Brookwood Dr, Portage, Michigan |
| Authorized Official Name and Position | Robert J. Sheppard (PSYCHOLOGIST) |
| Authorized Official Contact | 2693036296 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Robert J. Sheppard Phd Pllc 8339 Brookwood Dr Portage MI 49024-5207 Ph: (269) 303-6296 | Robert J. Sheppard Phd Pllc 8339 Brookwood Dr Portage MI 49024-5207 Ph: (269) 303-6296 |
| NPI Number | 1083213631 |
|---|---|
| Provider Enumeration Date | 10/23/2020 |
| Last Update Date | 10/24/2020 |
| Certification Date | 10/24/2020 |
| Medicare PECOS PAC ID | 4789091356 |
|---|---|
| Medicare Enrollment ID | O20210326000336 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083213631 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Robert J Sheppard |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1457333692 PECOS PAC ID: 8729068580 Enrollment ID: I20040722000329 |
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