Provider Demographics
NPI:1053168856
Name:SHEPLEY, LEWIS BAKER JR (HIS)
Entity type:Individual
Prefix:MR
First Name:LEWIS
Middle Name:BAKER
Last Name:SHEPLEY
Suffix:JR
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 BROOKTREE DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2743
Mailing Address - Country:US
Mailing Address - Phone:314-757-5619
Mailing Address - Fax:
Practice Address - Street 1:426 BROOKTREE DR
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2743
Practice Address - Country:US
Practice Address - Phone:314-757-5619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006006561237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist