Provider Demographics
NPI:1033523451
Name:WILLIAMS, AMBER (ECE, SCGE, DT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:ECE, SCGE, DT
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:FREUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:535 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT ZION
Mailing Address - State:IL
Mailing Address - Zip Code:62549-1559
Mailing Address - Country:US
Mailing Address - Phone:217-791-1749
Mailing Address - Fax:
Practice Address - Street 1:535 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:MOUNT ZION
Practice Address - State:IL
Practice Address - Zip Code:62549-1559
Practice Address - Country:US
Practice Address - Phone:217-791-1749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist