Provider Demographics
NPI:1700394384
Name:WILLIAMS, STEPHANIE (LM, CPM)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6536 QUAIL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-7904
Mailing Address - Country:US
Mailing Address - Phone:702-600-1016
Mailing Address - Fax:530-722-6768
Practice Address - Street 1:1727 SOUTH ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1812
Practice Address - Country:US
Practice Address - Phone:530-768-5051
Practice Address - Fax:530-722-6768
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM521176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife