Healthcare Provider Details

I. General information

NPI: 1417530478
Provider Name (Legal Business Name): AEQULIA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14840 SHEPARD DR
DOLTON IL
60419-2467
US

IV. Provider business mailing address

14840 SHEPARD DR
DOLTON IL
60419-2467
US

V. Phone/Fax

Practice location:
  • Phone: 773-449-0859
  • Fax: 773-787-2102
Mailing address:
  • Phone: 773-449-0859
  • Fax: 773-787-2102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: