Kathy Lynn Shapley, PH.D. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

112159 Issued in TX

Practice address

1501 W Bradley Ave
Peoria, IL 61625-0003

Phone

(210) 379-9162

NPI assigned

Nov 13, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Mississippi University for Women

  • Multi-Specialty Clinic/Center
  • Columbus, MS
  • NPI 1164422580
  NPD (past)

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

{
    "created_epoch": "1542067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788307200000",
    "number": "1639647233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 W BRADLEY AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616250003",
            "telephone_number": "210-379-9162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 W BRADLEY AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616250003",
            "telephone_number": "210-379-9162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAPLEY",
        "first_name": "KATHY",
        "middle_name": "LYNN",
        "name_prefix": "Prof.",
        "credential": "PH.D. CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-11-13",
        "last_updated": "2026-09-02",
        "certification_date": "2026-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "2600551",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "112159",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146017029",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jayma R. Shane, CRNA
• Joshua I Shane, LPC
• Melissa A Shane, LCPC
• Peter Shanine, R.PH
• Vinoda Shanthappa, MD
• Christopher O Sharkey, MS, ATC
• Amit Bhushan Sharma, AMIT SHARMA
• Sharon Health Care Elms, Inc.
• Sharon Health Care Pines Inc
• Sharon Health Care Willows Inc

• Speech-Language Pathologist in Peoria, IL
• Providers in Peoria, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.