Healthcare Provider Details

I. General information

NPI: 1629988753
Provider Name (Legal Business Name): NEVAEH ELYSE MCWILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 W ELLIOT RD STE 203
GILBERT AZ
85233-5142
US

IV. Provider business mailing address

4510 E BANNER GATEWAY DR APT 3053
MESA AZ
85206-4759
US

V. Phone/Fax

Practice location:
  • Phone: 480-265-5557
  • Fax:
Mailing address:
  • Phone: 480-265-5557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number17889
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: