Active NPI
Shannon Henderson
- Professional Counselor
- Rockford, IL
National Provider Identifier
1871079137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- Practice address
- 5906 Elaine Dr Ste 103
Rockford, IL 61108-2467 - Phone
- (779) 210-3453
- NPI assigned
- Jul 19, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Professional Counselor | 101YP2500X | Primary |
Addresses
Primary practice location
5906 Elaine Dr Ste 103
Rockford, IL 61108-2467
Mailing address
5906 Elaine Dr Ste 103
Rockford, IL 61108-2467
Other practice location 1
8616 Northern Ave
Rockford, IL 61107-5309
Phone (815) 332-8003
Other names 1
- Shannon Stone
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Willow Creek Counseling LLC | Professional | Current | Accepting new patients |
Locations
5906 Elaine Dr
Ste 103
Rockford, IL 61108
Phone (779) 210-3453
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736467200000",
"number": "1871079137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5906 ELAINE DR STE 103",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611082467"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5906 ELAINE DR STE 103",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611082467",
"telephone_number": "779-210-3453"
}
],
"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": "HENDERSON",
"first_name": "SHANNON",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-07-19",
"last_updated": "2025-01-10",
"certification_date": "2025-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SHANNON",
"last_name": "STONE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2025; 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.