Provider Demographics
NPI:1134575236
Name:WILLIAMS, LATOYA K (PSYD)
Entity type:Individual
Prefix:DR
First Name:LATOYA
Middle Name:K
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 ROOSEVELT DR APT 5
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53090-1970
Mailing Address - Country:US
Mailing Address - Phone:262-343-1139
Mailing Address - Fax:
Practice Address - Street 1:9235 W CAPITOL DR UNIT 402
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1567
Practice Address - Country:US
Practice Address - Phone:262-343-1139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI319457103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical