Active NPI
William J McIlquham
- Speech-Language Pathologist
- Phoenix, AZ
National Provider Identifier
1407987118
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP0435
- Practice address
- 4502 N Central Ave
Phoenix Union High School District
Phoenix, AZ 85012-1817 - Phone
- (602) 764-8561
- NPI assigned
- Mar 7, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP0435 | AZ | Primary |
Addresses
Primary practice location
4502 N Central Ave
Phoenix Union High School District
Phoenix, AZ 85012-1817
Mailing address
21538 N 65TH Ave
Glendale, AZ 85308-6410
Phone (623) 362-1947
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 801698 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP0435 | AZ | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1407987118",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21538 N 65TH AVE",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853086410",
"telephone_number": "623-362-1947"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4502 N CENTRAL AVE",
"address_2": "PHOENIX UNION HIGH SCHOOL DISTRICT",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850121817",
"telephone_number": "602-764-8561"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCILQUHAM",
"first_name": "WILLIAM",
"middle_name": "J",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-07",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "AZ",
"license": "SLP0435",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "801698",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.