DR. JO SHACKELFORD (ED.D., CCC-SLP) – Speech-Language Pathologist, NPI 1740527100

DR. JO SHACKELFORD (ED.D., CCC-SLP) is a healthcare provider. based in Bowling green, Kentucky. specializing in QUALIFIED SPEECH LANGUAGE PATHOLOGIST. They hold the professional credentials ED.D., CCC-SLP. They hold a License No. 1374 (KY). The NPI Number for DR. JO SHACKELFORD (ED.D., CCC-SLP) is 1740527100

Main info

Female
40 Years Of Experience
Name
DR. JO SHACKELFORD (ED.D., CCC-SLP)
NPI
1740527100
Phone
(270) 202-3316
Address
1133 CHESTNUT ST., #3
Enumeration Date
4 January 2013
Deactivation Date
16 April 2018
Reactivation Date
26 February 2020
Last Update Date
26 February 2020

Doctor Profile

Medical School Name
OTHER
Secondary Phone
4135452565
Graduation Year
1986 (40 years ago)
PAC ID
9638302938
Group Practice PAC ID
6507843760
Professional Enrollment ID
I20240202001787
Address ID
MA010039296AM358XXSTXX400
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience50
Completeness75
Years active:13State licenses:1Digital endpointsOther names

146 QUALIFIED SPEECH LANGUAGE PATHOLOGIST in KY

Provider Addresses for DR. JO SHACKELFORD (ED.D., CCC-SLP)

  • 1133 CHESTNUT ST., #3

    BOWLING GREEN, KY 42101

    Phone: (270) 202-3316

    Type: Mailing

  • 1918 MOSSWOOD DR

    BOWLING GREEN, KY 421044550

    Phone: (270) 202-3316

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-02-02

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20240202001787IQualified Speech Language PathologistMATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 42101)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 6507843760View full group profile
NameSpecialtyState
Qualified Speech Language PathologistMA
Qualified AudiologistMA
Qualified Speech Language PathologistMA
Qualified AudiologistMA
Qualified AudiologistMA

Reviews

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Frequently asked questions

Can I use this page to confirm DR. JO SHACKELFORD (ED.D., CCC-SLP)'s NPI?
Yes. DR. JO SHACKELFORD (ED.D., CCC-SLP) is listed with NPI 1740527100 in the public NPI dataset.
Can I rely on DR. JO SHACKELFORD (ED.D., CCC-SLP) being an active provider?
As of the registry snapshot, DR. JO SHACKELFORD (ED.D., CCC-SLP) is marked active.
What is DR. JO SHACKELFORD (ED.D., CCC-SLP)'s primary classification?
Speech-Language Pathologist is the headline specialty for DR. JO SHACKELFORD (ED.D., CCC-SLP) here. Clinical services aligned with this taxonomy classification.
Where is DR. JO SHACKELFORD (ED.D., CCC-SLP) based?
DR. JO SHACKELFORD (ED.D., CCC-SLP) is tied to Bowling Green, Kentucky in the data we show; additional addresses may exist on the full record.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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