NPIMap

Individual provider Active NPI

Shellie Dee Locke, PH.D.

  • Clinical Psychologist
  • Kenosha, WI
National Provider Identifier
1336319979
Registry record updated Mar 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071.007310 Issued in IL
Practice address
9020 15TH Ave
Kenosha, WI 53143-6803
Phone
(708) 224-7442
NPI assigned
Mar 11, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 11, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 2660-057 WI
Clinical Neuropsychologist 103G00000X 071.007310 IL
Clinical Psychologist 103TC0700X 2660-057 WI
Clinical Psychologist 103TC0700X 071.007310 IL Primary

Addresses

Primary practice location

9020 15TH Ave
Kenosha, WI 53143-6803

Mailing address

9020 15TH Ave
Kenosha, WI 53143-6803
Phone (708) 224-7442

Other identifiers 1

IdentifierTypeStateIssuer
40994300MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121127000698 WI Practitioner - Clinical Psychologist 5991844102 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1630 Chippewa Dr
Rhinelander, WI 54501-9503
Phone (715) 361-5480

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
071.007310ILMDClinical Psychologist
2660-057WIMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Rhinelander & Tomahawk Hospitals & Clinics, Inc CurrentSince Jan 2, 2025 Accepting new patients
Aspirus Rhinelander & Tomahawk Hospitals & Clinics, Inc. CurrentSince Jan 2, 2025 Accepting new patients
Oak Forest Psychological Service Clinical Past Accepting new patients
Locke Consulting Services Company Past Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

400 W Glen St
Crandon, WI 54520
Phone (715) 478-3318

1630 N Chippewa Dr
Rhinelander, WI 54501
Phone (715) 361-5480

2251 N Shore Dr
Ste 100
Rhinelander, WI 54501
Phone (715) 361-2074

401 W Mohawk Dr
Ste 100
Tomahawk, WI 54487
Phone (715) 453-7700

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205193600000",
    "number": "1336319979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9020 15TH AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531436803",
            "telephone_number": "708-224-7442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9020 15TH AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531436803",
            "telephone_number": "708-224-7442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOCKE",
        "first_name": "SHELLIE",
        "middle_name": "DEE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-03-11",
        "last_updated": "2008-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "WI",
            "license": "2660-057",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "IL",
            "license": "071.007310",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "2660-057",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.007310",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40994300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

Verify at the official NPI Registry.