Provider Demographics
NPI:1215571930
Name:WILLIAMS, GLORIA ANN
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:ANN
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 1:1635 PALMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-1776
Mailing Address - Country:US
Mailing Address - Phone:301-266-2648
Mailing Address - Fax:
Practice Address - Street 1:115 S REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-6958
Practice Address - Country:US
Practice Address - Phone:419-725-6631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7728691744P3200X
OH205526163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management