Provider Demographics
NPI:1649315466
Name:SOUTHER, WILLIAM D (MSW, LICSW)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:D
Last Name:SOUTHER
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4989 355TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-5581
Mailing Address - Country:US
Mailing Address - Phone:651-237-0803
Mailing Address - Fax:
Practice Address - Street 1:5833 PECAN ST
Practice Address - Street 2:SUITE A2
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-6689
Practice Address - Country:US
Practice Address - Phone:651-237-0628
Practice Address - Fax:651-237-0631
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN74841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical