Provider Demographics
NPI:1487195327
Name:WILLIAMS, STAR ORA (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:STAR
Middle Name:ORA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ORA
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7401 METRO BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-3062
Mailing Address - Country:US
Mailing Address - Phone:612-268-5858
Mailing Address - Fax:612-268-5868
Practice Address - Street 1:3251 FERNBROOK LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-5352
Practice Address - Country:US
Practice Address - Phone:612-268-5858
Practice Address - Fax:612-268-5868
Is Sole Proprietor?:No
Enumeration Date:2017-03-11
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
MN29948104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN29948OtherPROFESSIONAL LICENSE