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General NPI Number Information
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NPI Number | 1598185431
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Entity Type | Organization
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Legal Business Name | CONNECTIONS SPEECH & LANGUAGE SERVICES
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Dates
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Enumeration Date | 04/18/2014
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Last Update Date | 04/18/2014
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Provider Practice Location Address
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Address Line | 1918 MOSSWOOD DR
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City | BOWLING GREEN
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State | KY
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Zip | 42104-4550
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Country | US
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Telephone | 270-202-3316
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Fax |
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Provider Business Mailing Address
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Address Line | 1918 MOSSWOOD DR
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City | BOWLING GREEN
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State | KY
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Zip | 42104-4550
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Country | US
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Telephone | 270-202-3316
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JO SHACKELFORD
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Credential | ED.D., CCC-SLP
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Telephone | 270-202-3316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 1374
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License Number State | KY
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