Provider Demographics
NPI:1093148165
Name:WILLIAMS, ANGELA ANNE (APSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:ANNE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8503 75TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7620
Mailing Address - Country:US
Mailing Address - Phone:262-654-9370
Mailing Address - Fax:262-654-9379
Practice Address - Street 1:8503 75TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7620
Practice Address - Country:US
Practice Address - Phone:262-654-9370
Practice Address - Fax:262-654-9379
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8092-123104100000X
WI162959-130104100000X
WI128369-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker