Emma Shackleton, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180.014466 Issued in IL

Practice address

695 N Perryville Rd Ste 4
Rockford, IL 61107-6225

Phone

(779) 368-0060

NPI assigned

Jul 19, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI, IL2 enrollments

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Enlightened Ways Therapy, LLC

  • Professional Counselor
  • Beloit, WI
  • NPI 1073250437

  IL

  Medicare reassignment NPD

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

{
    "created_epoch": "1531958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682899200000",
    "number": "1396221669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "695 N PERRYVILLE RD STE 4",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611076225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "695 N PERRYVILLE RD STE 4",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611076225",
            "telephone_number": "779-368-0060"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8616 Northern Ave",
            "address_purpose": "LOCATION",
            "city": "Rockford",
            "state": "IL",
            "postal_code": "611075309",
            "country_code": "US",
            "telephone_number": "815-332-8003",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHACKLETON",
        "first_name": "EMMA",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-19",
        "last_updated": "2023-05-01",
        "certification_date": "2023-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.014466",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adam Haugen Setter, PHARMD
• James Melvin Severson III, MD
• Stephanie Severson, LMFT
• Ashley Seyfert
• Vanessa Michele Shabani
• Obaid Shafiq, MD
• Shah Foot & Ankle LLC
• Shah Vision Consultants Inc
• Anshul Mikin Shah
• Aruna S Shah, M.D.

• Professional Counselor in Rockford, IL
• Providers in Rockford, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.