Shaquala Phillips – Social Worker in Taylor, MI

Key facts

NPI: 1104449958
Entity type: Individual (NPI type 1)
Primary specialty: Social Worker 104100000X
License: 6852090727 (MI)
Practice address: 20300 Superior Rd
Taylor, MI 48180-6331
Phone: (248) 636-3145
NPI assigned: May 27, 2020
Sex: Female
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
6852090727	MI	MD	Social Worker

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Social Worker	104100000X	6852090727	MI	Yes

Addresses

Primary practice location

20300 Superior Rd
Taylor, MI 48180-6331

Mailing address

65 Oneida St
Pontiac, MI 48341-1624

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 20, 2022.

{
    "created_epoch": "1590537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663632000000",
    "number": "1104449958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 ONEIDA ST",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483411624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20300 SUPERIOR RD",
            "city": "TAYLOR",
            "state": "MI",
            "postal_code": "481806331",
            "telephone_number": "248-636-3145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "SHAQUALA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-27",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6852090727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Taylor, MI

All providers in Taylor, MI · Social Worker in Michigan

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 20, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.