Provider Demographics
NPI:1730444068
Name:INGHAM, WILLILAM L (HIS)
Entity type:Individual
Prefix:
First Name:WILLILAM
Middle Name:L
Last Name:INGHAM
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E BAY DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2532
Mailing Address - Country:US
Mailing Address - Phone:727-585-8521
Mailing Address - Fax:727-584-1973
Practice Address - Street 1:800 E BAY DR
Practice Address - Street 2:SUITE G
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2532
Practice Address - Country:US
Practice Address - Phone:727-585-8521
Practice Address - Fax:727-584-1973
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0002235237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist