Active NPI
Shelby Jackson, LSW
- Social Worker
- Shelby, OH
National Provider Identifier
1235749763
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- S.1700526
- Practice address
- 2775 State Route 39
Shelby, OH 44875-9466 - Phone
- (419) 747-3322
- NPI assigned
- Aug 10, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | S.1700526 | OH | Primary |
Addresses
Primary practice location
2775 State Route 39
Shelby, OH 44875-9466
Mailing address
2775 State Route 39
Shelby, OH 44875-9466
Phone (419) 747-3322
Other names 1
- Shelby Smith
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S.1700526 | OH | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cornell Abraxas Group, LLC | Current | Accepting new patients | |
| Cornell Abraxas Group, LLC | Past | Accepting new patients |
Locations
2775 State Route 39
Shelby, OH 44875
Phone (419) 747-3322
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Children's Substance Abuse Rehabilitation Facility
- Shelby, OH
- NPI 1134385669
-
- Children's Substance Abuse Rehabilitation Facility
- Shelby, OH
- NPI 1376518902
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597017600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1759276800000",
"number": "1235749763",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2775 STATE ROUTE 39",
"city": "SHELBY",
"state": "OH",
"postal_code": "448759466",
"telephone_number": "419-747-3322"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2775 STATE ROUTE 39",
"city": "SHELBY",
"state": "OH",
"postal_code": "448759466",
"telephone_number": "419-747-3322"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SHELBY",
"credential": "LSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-08-10",
"last_updated": "2025-10-01",
"certification_date": "2025-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "S.1700526",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SHELBY",
"last_name": "SMITH",
"credential": "LSW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Shelby, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.