Healthcare Provider Details

I. General information

NPI: 1508772302
Provider Name (Legal Business Name): ISABELLE NICOLE SHACKELFORD MS, CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3162 W MLK BLVD STE 2
FAYETTEVILLE AR
72704-7679
US

IV. Provider business mailing address

3823 BELINDA LN
SPRINGDALE AR
72764-7690
US

V. Phone/Fax

Practice location:
  • Phone: 479-435-6636
  • Fax:
Mailing address:
  • Phone: 479-409-0451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number203740
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: