Provider Demographics
NPI:1780817932
Name:WILLIAMS, PATRICIA CLOTHILDE
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:CLOTHILDE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:CLOTHILDE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8249 SOUTH DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-3437
Mailing Address - Country:US
Mailing Address - Phone:773-425-1151
Mailing Address - Fax:
Practice Address - Street 1:8249 SOUTH DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-3437
Practice Address - Country:US
Practice Address - Phone:773-425-1151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator