Active NPI
Shelley Helena Jackson, M.S.
- Speech-Language Pathologist
- Lexington, KY
National Provider Identifier
1053778308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 1272
- Practice address
- 448 Lewis Hargett Cir
Lexington, KY 40503-3594 - Phone
- (859) 313-5250
- Fax
- (859) 373-8577
- NPI assigned
- Jan 18, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 1272 | KY | Primary |
Addresses
Primary practice location
448 Lewis Hargett Cir
Lexington, KY 40503-3594
Mailing address
448 Lewis Hargett Cir
Lexington, KY 40503-3594
Phone (859) 313-5250
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1272 | KY | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1453075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453075200000",
"number": "1053778308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "448 LEWIS HARGETT CIR",
"city": "LEXINGTON",
"state": "KY",
"postal_code": "405033594",
"telephone_number": "859-313-5250",
"fax_number": "859-373-8577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "448 LEWIS HARGETT CIR",
"city": "LEXINGTON",
"state": "KY",
"postal_code": "405033594",
"telephone_number": "859-313-5250",
"fax_number": "859-373-8577"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SHELLEY",
"middle_name": "HELENA",
"credential": "M.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-01-18",
"last_updated": "2016-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "KY",
"license": "1272",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lexington, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.