Provider Demographics
NPI:1003947698
Name:WILLCOXON, RONALD L (PHD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
Last Name:WILLCOXON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18647 N 20TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-3074
Mailing Address - Country:US
Mailing Address - Phone:602-867-9660
Mailing Address - Fax:602-867-2762
Practice Address - Street 1:18647 N 20TH STREET
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-3074
Practice Address - Country:US
Practice Address - Phone:602-867-9660
Practice Address - Fax:602-867-2762
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3018103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ732728Medicaid
AZZPHD972Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION