Provider Demographics
NPI:1457370132
Name:WILLIAMS, EMILY JO (LCSW-PIP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JO
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW-PIP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:JO
Other - Last Name:NOVAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-PIP
Mailing Address - Street 1:24255 SD HIGHWAY 50
Mailing Address - Street 2:
Mailing Address - City:CHAMBERLAIN
Mailing Address - State:SD
Mailing Address - Zip Code:57325-6017
Mailing Address - Country:US
Mailing Address - Phone:605-245-1527
Mailing Address - Fax:605-245-2150
Practice Address - Street 1:24255 SD HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:CHAMBERLAIN
Practice Address - State:SD
Practice Address - Zip Code:57325-6017
Practice Address - Country:US
Practice Address - Phone:605-245-1527
Practice Address - Fax:605-245-2150
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD17651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5549010Medicaid
SD8HC491Medicare ID - Type Unspecified