Individual
JORDAN SHEPHERD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
600 TOLL GATE RD, WARWICK, RI 02886-2717
(401) 477-9495
(401) 205-3582
Mailing address
600 TOLL GATE RD, WARWICK, RI 02886-2717
(401) 477-9495
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
LBA00238
RI
103K00000X
Behavior Analyst
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013505676
—
RI
Enumeration date
12/10/2020
Last updated
07/11/2022
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