Shelby Lynn Jack, M.S., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Practice address

1501 Inverness Dr
Lawrence, KS 66047-1870

Phone

(417) 209-6270

NPI assigned

Oct 29, 2019

Last updated

Aug 12, 2024By 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 MO

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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.

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  Speech-Language Pathologist

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• Aegis Group Practice LLC

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  Speech-Language Pathologist

  NPD

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

{
    "created_epoch": "1572307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723420800000",
    "number": "1992349344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 E 100TH TER",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641313311",
            "telephone_number": "417-209-6270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 INVERNESS DR",
            "city": "LAWRENCE",
            "state": "KS",
            "postal_code": "660471870",
            "telephone_number": "417-209-6270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "SHELBY",
        "middle_name": "LYNN",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-29",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Hong U. Ishaku
• Rachel Leigh Jackson Meier, LIMHP, LMHP, LCPC
• Jackson Psychotherapy, LLC (The Satori Program)
• Jackson Psychotherapy, LLC
• Heather Jackson, LPC
• Kaela Jackson, COTA/L

• Speech-Language Pathologist in Lawrence, KS
• Providers in Lawrence, KS by specialty
• Speech-Language Pathologist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.