Provider Demographics
NPI:1992349344
Name:JACK, SHELBY LYNN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:LYNN
Last Name:JACK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 E 100TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-3311
Mailing Address - Country:US
Mailing Address - Phone:417-209-6270
Mailing Address - Fax:
Practice Address - Street 1:1501 INVERNESS DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-1870
Practice Address - Country:US
Practice Address - Phone:417-209-6270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist