Provider Demographics
NPI:1134820293
Name:WILLIAMS, IRA NOVELETTA
Entity type:Individual
Prefix:
First Name:IRA
Middle Name:NOVELETTA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18314 115TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-8876
Mailing Address - Country:US
Mailing Address - Phone:253-316-9756
Mailing Address - Fax:
Practice Address - Street 1:18314 115TH AVE E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-8876
Practice Address - Country:US
Practice Address - Phone:253-316-9756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst