Provider Demographics
NPI:1689352585
Name:SHEPHERD, LUKE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 KINNEY AVE NW
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:MI
Mailing Address - Zip Code:49534-2116
Mailing Address - Country:US
Mailing Address - Phone:248-767-9913
Mailing Address - Fax:
Practice Address - Street 1:1924 KINNEY AVE NW
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MI
Practice Address - Zip Code:49534-2116
Practice Address - Country:US
Practice Address - Phone:248-767-9913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101007621235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist