Provider Demographics
NPI:1790028637
Name:WINDLESS-WILLIAMS, JACQUELINE DENISE (LSW, MSW)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:DENISE
Last Name:WINDLESS-WILLIAMS
Suffix:
Gender:F
Credentials:LSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3823 S BEVERLY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2216
Mailing Address - Country:US
Mailing Address - Phone:419-255-9585
Mailing Address - Fax:419-255-0729
Practice Address - Street 1:3350 COLLINGWOOD BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43610-1173
Practice Address - Country:US
Practice Address - Phone:419-255-9585
Practice Address - Fax:419-255-0729
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS-00195371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical