Jo Shackelford, ED.D., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

1374 Issued in KY

Practice address

1918 Mosswood Dr
Bowling Green, KY 42104-4550

Phone

(270) 202-3316

NPI assigned

Jan 4, 2013

Reactivated

Feb 26, 2020

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

Other names 1

• Jo McElroy Fitzherbert Former name

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Specialty

Qualified Speech Language Pathologist

Education

Other, 1986

Medicare assignment

May accept Medicare assignment

Group practices

University of MassachusettsGroup PAC ID 6507843760, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• University of Massachusetts

  • Audiologist
  • Amherst, MA
  • NPI 1821171059

  Speech-Language Pathologist

  Medicare reassignment Care Compare group NPD
• University of Massachusetts

  • Audiologist
  • Amherst, MA
  • NPI 1538691522

  Speech-Language Pathologist

  NPD (past)

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

{
    "created_epoch": "1357257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582675200000",
    "number": "1740527100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 CHESTNUT ST., #3",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "42101",
            "telephone_number": "270-202-3316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1918 MOSSWOOD DR",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421044550",
            "telephone_number": "270-202-3316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKELFORD",
        "first_name": "JO",
        "name_prefix": "Dr.",
        "credential": "ED.D., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-04",
        "last_updated": "2020-02-26",
        "certification_date": "2020-02-26",
        "deactivation_date": "2018-04-16",
        "reactivation_date": "2020-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "KY",
            "license": "1374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JO",
            "last_name": "MCELROY FITZHERBERT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Vanessa Lynne Sewell
• Kristen Sexton
• Rachel Sexton, BHS
• Sfreeman Inc.
• Hannah Nicole Shackelford, BS, RBT
• Laura Shacklette, LPCC
• Emily Elizabeth Shaddox
• David Shadowen, M.D.
• Vivek Prakash Shah
• Morteza Shahmir, M.D.

• Speech-Language Pathologist in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Speech-Language Pathologist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.