Active NPI
Jessie Shacklette, ED.S.
- School Psychologist
- Indianapolis, IN
National Provider Identifier
1609693175
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 10346260
- Practice address
- 6548 Orinoco Ave
Indianapolis, IN 46227-4820 - Phone
- (317) 789-3728
- NPI assigned
- Sep 25, 2024
- 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 |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 10346260 | IN | Primary |
Addresses
Primary practice location
6548 Orinoco Ave
Indianapolis, IN 46227-4820
Mailing address
6548 Orinoco Ave
Indianapolis, IN 46227-4820
Phone (317) 789-3728
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 |
|---|---|---|---|
| 10346260 | IN | MD | School Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Metropolitan School District of Perry Township | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Local Education Agency (LEA)
- Indianapolis, IN
- NPI 1073859146
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1727222400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727222400000",
"number": "1609693175",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6548 ORINOCO AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462274820",
"telephone_number": "317-789-3728"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6548 ORINOCO AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462274820",
"telephone_number": "317-789-3728"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHACKLETTE",
"first_name": "JESSIE",
"name_prefix": "Ms.",
"credential": "ED.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-09-25",
"last_updated": "2024-09-25",
"certification_date": "2024-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "IN",
"license": "10346260",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.