Nicole Shackelford, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LMSW-40005 Issued in ID

Practice address

318 W Washington Ave
Aberdeen, ID 83210-5502

Phone

(208) 397-4113

NPI assigned

Jan 28, 2021

Last updated

Jan 28, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

High Country Behavioral HealthGroup PAC ID 0648454587, 44 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• High Country Behavioral Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Idaho Falls, ID
  • NPI 1295379865
  Medicare reassignment Care Compare group NPD
• High Country Behavioral Health

  • Mental Illness Community Based Residential Treatment Facility
  • Douglas, WY
  • NPI 1750113882
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611792000000",
    "number": "1497346944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2947 W 1700 S",
            "city": "ABERDEEN",
            "state": "ID",
            "postal_code": "832101628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "318 W WASHINGTON AVE",
            "city": "ABERDEEN",
            "state": "ID",
            "postal_code": "832105502",
            "telephone_number": "208-397-4113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKELFORD",
        "first_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-28",
        "last_updated": "2021-01-28",
        "certification_date": "2021-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LMSW-40005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Health West, Inc. (Health West Aberdeen Clinic)
• Debra S McKay, PA-C
• Power County Hospital District (Aberdeen Family Clinic)
• Heather Ann Schaper, PA
• Brent Tracy Schvaneveldt, D.M.D.
• David William Vaughn
• Velia Velasquez
• Wallace Pharmacy Inc (Wallace Drug)
• Dwight D. Wallace, PHARMD
• Nicholas Wiilliam Winn, PA-C

• Clinical Social Worker in Aberdeen, ID
• Providers in Aberdeen, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.