Basic Information
| Provider Information | |||||||||
| NPI: | 1609915008 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHEPHERD | ||||||||
| FirstName: | LEIGH | ||||||||
| MiddleName: | KATHRYN | ||||||||
| NamePrefix: | MISS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3887 | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277100001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196846271 | ||||||||
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| Practice Location | |||||||||
| Address1: | 40 DUKE MEDICINE CIR | ||||||||
| Address2: | CLINIC 1-I | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277104000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196843451 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 04/22/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 7528 | NC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 1503J | 01 | NC | BCBS OF NC | OTHER | 7412653 | 05 | NC | MEDICAID |