Provider Demographics
NPI:1003598681
Name:WILLIAMS, CALISA
Entity Type:Individual
Prefix:
First Name:CALISA
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 1:7600 W. ROOSEVELT RD
Mailing Address - Street 2:LOWER LEVEL #172
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-2273
Mailing Address - Country:US
Mailing Address - Phone:312-388-2909
Mailing Address - Fax:
Practice Address - Street 1:7600 W. ROOSEVELT RD
Practice Address - Street 2:LOWER LEVEL #172
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-2273
Practice Address - Country:US
Practice Address - Phone:312-388-2909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker