Provider Demographics
NPI:1639504079
Name:WILLIAMS BRADSHAW, WINIFRED (MS, CRC, LCPC)
Entity Type:Individual
Prefix:MS
First Name:WINIFRED
Middle Name:
Last Name:WILLIAMS BRADSHAW
Suffix:
Gender:F
Credentials:MS, CRC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 W 102ND PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-1916
Mailing Address - Country:US
Mailing Address - Phone:847-461-8718
Mailing Address - Fax:
Practice Address - Street 1:329 W 102ND PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-1916
Practice Address - Country:US
Practice Address - Phone:847-461-8718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X, 101YP2500X, 172V00000X, 171W00000X, 170300000X, 104100000X, 374K00000X, 172A00000X
IL180008522102L00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No172V00000XOther Service ProvidersCommunity Health Worker
No171W00000XOther Service ProvidersContractor
No170300000XOther Service ProvidersGenetic Counselor, MS
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No172A00000XOther Service ProvidersDriver