Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jacqualyn D Shannon

Individual provider Developmental Therapist · NPI 1114731403

Jacqualyn D Shannon is a Developmental Therapist in Bowling Green, Kentucky. Practices as a sole proprietor. Licensed in Kentucky.

Licensed in
KY
In the registry since
2025

Practice location Address checks out

325 Audley Ave Apt 4
Bowling Green, KY 42101-4489
Phone: (615) 423-5017
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Developmental Therapist (primary) Taxonomy 222Q00000X · Licence 201237255 (KY)

Record details

NPI number1114731403
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedFebruary 5, 2025
Last updated in NPPESFebruary 5, 2025
Certification dateFebruary 5, 2025
Mailing address325 Audley Ave Apt 4, Bowling Green, KY 42101-4489

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