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SHELBY LYNN JACK M.S., CCC-SLP
NPI 1992349344
Speech-Language Pathologist in Lawrence, KS

Active since October 29, 2019
1501 INVERNESS DR, LAWRENCE, KS 66047(417) 209-6270 Get Directions Write a Review

NPPES record last updated: August 12, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Aug 12, 2024, Oct 1, 2020, Oct 29, 2019 (3 updates tracked since 2019).

About Shelby Lynn Jack M.s., Ccc-slp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHELBY LYNN JACK M.S., CCC-SLP (NPI 1992349344) is an individual speech-language pathologist provider in Lawrence, Kansas and active in the NPI registry since October 2019.

NPPES Registry Identity

NPI1992349344
Entity TypeIndividualFemale
Primary Taxonomy235Z00000X
Provider Legal NameSHELBY LYNN JACKCredential: M.S., CCC-SLP
Location Address1501 INVERNESS DRLawrence, KS 66047-1870
Mailing Address1311 E 100th TerKansas City, MO 64131-3311 · (417) 209-6270
Phone(417) 209-6270
Sole ProprietorNo
Enumeration DateOctober 29, 2019
Last NPPES UpdateAugust 12, 20243 updates tracked since enumeration
NPPES CertifiedAugust 8, 2024
✔ NPI 1992349344 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpeech-Language PathologistSpeech, Language and Hearing Service Providers
Taxonomy Code235Z00000X
Definition
The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the areas of communication and swallowing across the life span from infancy through geriatrics. Speech-language pathologists address typical and atypical impairments and disorders related to communication and swallowing in the areas of speech sound production, resonance, voice, fluency, language (comprehension and expression), cognition, and feeding and swallowing.
1501 INVERNESS DR, Lawrence, KS 66047
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Shelby Lynn Jack M.s., Ccc-slp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Billing Reassignments

2

Medicare enrollment records show Shelby Jack reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Aegis Group Practice LLC
41 mi
Physical Therapist
9101 NORTH AMBASSADOR DRIVE
Kansas City, MO 64154
  • Reassigned Medicare billing, Missouri enrollment
  • 34 clinicians in this Medicare group
NPI 1134780737 (800) 444-6845
Legacy Healthcare Services Inc.
233 mi
Physical Therapist
1481 MARBACH DR
Washington, MO 63090
  • Reassigned Medicare billing, Missouri enrollment
  • 73 clinicians in this Medicare group
NPI 1407487366 (855) 239-3467

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PATRICIA PUTNAM COTA
Occupational Therapy Assistant
1501 INVERNESS DR
LAWRENCE, KS 66047
Douglas County (785) 838-8000
AMANDA STEFFEN
Occupational Therapist
1501 INVERNESS DR
LAWRENCE, KS 66047
Douglas County (785) 838-8000
SARAH JANE WILLIAMS C.O.T.A
Occupational Therapy Assistant
1501 INVERNESS DR
LAWRENCE, KS 66047
Douglas County (785) 838-8000
MS. JONI UNRUH FORNELLI OTR
Occupational Therapist
1501 INVERNESS DR
LAWRENCE, KS 66047
Douglas County (785) 838-8000
SNH TOTO TENANT LLC
Skilled Nursing Facility
1501 INVERNESS DR
LAWRENCE, KS 66047
Douglas County (785) 838-8000
MRS. LARISSA NOEL MITCHELL DPT
Physical Therapist
1501 INVERNESS DR
LAWRENCE, KS 66047
Douglas County (785) 838-8000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shelby Jack's NPI number?

The NPI number for Shelby Jack is 1992349344. It was assigned to this individual provider in the NPPES registry on October 29, 2019.

Where is Shelby Jack located?

Shelby Jack practices at 1501 Inverness Dr, Lawrence, KS 66047. The listed phone number is (417) 209-6270.

What is Shelby Jack's specialty?

The primary specialty registered for this NPI is Speech-Language Pathologist with taxonomy code 235Z00000X.

Is Shelby Jack enrolled in Medicare?

Yes. Shelby Jack is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Shelby Jack's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Shelby Jack reassigns Medicare benefits to 2 organizations: Aegis Group Practice LLC (Kansas City, MO) and Legacy Healthcare Services Inc. (Washington, MO). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Shelby Jack's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Shelby Jack was last updated on August 12, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.