Provider Demographics
NPI:1710440003
Name:WILLIAMS, RAQUILLA
Entity Type:Individual
Prefix:
First Name:RAQUILLA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14500 S RICHMOND AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:POSEN
Mailing Address - State:IL
Mailing Address - Zip Code:60469-1133
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14500 S RICHMOND AVE APT 3
Practice Address - Street 2:
Practice Address - City:POSEN
Practice Address - State:IL
Practice Address - Zip Code:60469-1133
Practice Address - Country:US
Practice Address - Phone:773-681-6346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist