Shantell Jackson

Primary specialty

Intellectual & Developmental Disabilities PsychologistTaxonomy code 103TM1800X

License

4303862 Issued in OH

Practice address

1834 Robindale St
Wickliffe, OH 44092-1843

Phone

(330) 368-2617

NPI assigned

Nov 15, 2020

Last updated

Nov 15, 2020By 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Purity Home Health Care LLC

  • Respite Care
  • East Cleveland, OH
  • NPI 1124898630
  NPD

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

{
    "created_epoch": "1605398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605398400000",
    "number": "1992307870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1834 ROBINDALE ST",
            "city": "WICKLIFFE",
            "state": "OH",
            "postal_code": "440921843",
            "telephone_number": "330-368-2617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1834 ROBINDALE ST",
            "city": "WICKLIFFE",
            "state": "OH",
            "postal_code": "440921843",
            "telephone_number": "330-368-2617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SHANTELL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-15",
        "last_updated": "2020-11-15",
        "certification_date": "2020-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "OH",
            "license": "4303862",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Howell
• Hanna Lynn Hromulak, AT, MPH, ATC
• Rachel Elaine Ignasiak, MS, OTR/L
• Integrations Treatment Center
• Vyacheslav Isakov, M.D.
• Gwenette Maurell James, LISW-S
• Ronald James
• Chelsea Marie Johns, MS
• Joshuas House(Lane Leasing Inc)
• Kathiet Greene, MD, Inc

• Intellectual & Developmental Disabilities Psychologist in Wickliffe, OH
• Providers in Wickliffe, OH by specialty
• Intellectual & Developmental Disabilities Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2020; 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.