Provider Demographics
NPI:1073772307
Name:WILLIAMS, DEIRDRE BALLOU (ND)
Entity Type:Individual
Prefix:DR
First Name:DEIRDRE
Middle Name:BALLOU
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 WESTPORT RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-4524
Mailing Address - Country:US
Mailing Address - Phone:203-761-9638
Mailing Address - Fax:203-762-2988
Practice Address - Street 1:58 WESTPORT RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-4524
Practice Address - Country:US
Practice Address - Phone:203-761-9638
Practice Address - Fax:203-762-2988
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000097175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath