Individual
KANESSIA SHEPARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
9716 LAKE POINTE CT APT 101, UPPER MARLBORO, MD 20774-4714
(240) 788-7089
(240) 788-7089
Mailing address
9716 LAKE POINTE CT APT 101, UPPER MARLBORO, MD 20774-4714
(240) 788-7089
(240) 788-7089
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
05330
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141EN
NC BCBS
NC
05
—
7412441
—
NC
Enumeration date
12/21/2005
Last updated
03/26/2026
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