Basic Information
| Provider Information | |||||||||
| NPI: | 1619325586 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHEPHERD | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | TYLER | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | SLP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KEENEN | ||||||||
| OtherFirstName: | ERIN | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | SLP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4121 LITTLE SAVANNAH RD STE 132 | ||||||||
| Address2: | |||||||||
| City: | CULLOWHEE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287239688 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282277251 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | WESTERN CAROLINA UNIVERSITY | ||||||||
| Address2: | 4121 LITTLE SAVANNAH RD STE 132 | ||||||||
| City: | CULLOWHEE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287239688 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282277251 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2016 | ||||||||
| LastUpdateDate: | 09/02/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 1703063 | NC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.