Provider Demographics
NPI:1649533829
Name:WILLIAMS, JOHN
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 N SHERIDAN RD
Mailing Address - Street 2:APT. 5308
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1954
Mailing Address - Country:US
Mailing Address - Phone:773-575-1792
Mailing Address - Fax:
Practice Address - Street 1:5209 N CLARK ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2101
Practice Address - Country:US
Practice Address - Phone:773-575-1792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0152501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical