Provider Demographics
NPI:1134666928
Name:CANNING-WILLIAMS, EMILY STARR
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:STARR
Last Name:CANNING-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 1:16334 COUNTY ROAD 30
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-1207
Mailing Address - Country:US
Mailing Address - Phone:763-416-1799
Mailing Address - Fax:763-419-1949
Practice Address - Street 1:7225 HEMLOCK LN N
Practice Address - Street 2:214
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-5505
Practice Address - Country:US
Practice Address - Phone:218-539-0582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist