Reginald Willis

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

3101 Issued in LA

Practice address

1961 Midway St
Shreveport, LA 71108-2201

Phone

(318) 603-6300

NPI assigned

Aug 26, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1629936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629936000000",
    "number": "1992472997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1961 MIDWAY ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711082201",
            "telephone_number": "318-603-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1961 MIDWAY ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711082201",
            "telephone_number": "318-603-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "REGINALD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-26",
        "last_updated": "2021-08-26",
        "certification_date": "2021-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "LA",
            "license": "3101",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "235Z00000X",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rawillis@caddoschools.org",
            "affiliation": "N",
            "endpointDescription": "school",
            "address_1": "1961 Midway St",
            "city": "Shreveport",
            "state": "LA",
            "country_code": "US",
            "postal_code": "711082201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lakisha Willis
• Lindsey Willis, LPC
• Melanie Yvette Willis, FNP-C
• Michael B Willis, PA
• Nekeicha Willis
• Shalena Willis
• Tyekia Willis
• Willow Point Baptist Healing Heart Counseling Center
• Wills on the Geaux LLC
• Della Edwards Wills, LCSW

• Speech-Language Pathologist in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Speech-Language Pathologist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.