Provider Demographics
NPI:1164656856
Name:LILES, WILLIAM PERRY (MS, CCC/SLP)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PERRY
Last Name:LILES
Suffix:
Gender:M
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8075 MADISON BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2041
Mailing Address - Country:US
Mailing Address - Phone:256-656-9440
Mailing Address - Fax:
Practice Address - Street 1:8075 MADISON BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2041
Practice Address - Country:US
Practice Address - Phone:256-656-9440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1042235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist