Provider Demographics
NPI:1053726232
Name:SHEFFERD, TAMARA (LSCSW)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:SHEFFERD
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:1006 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434-1518
Mailing Address - Country:US
Mailing Address - Phone:785-220-1364
Mailing Address - Fax:
Practice Address - Street 1:700 OREGON ST STE 9
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:KS
Practice Address - Zip Code:66434-2232
Practice Address - Country:US
Practice Address - Phone:785-288-6253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9271104100000X
KS51981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker