Provider Demographics
NPI:1669914115
Name:WILLIAMS, BRIDGET THERESA (MS)
Entity type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:THERESA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:14116 STURGIS ROAD
Mailing Address - City:PIEDMONT
Mailing Address - State:SD
Mailing Address - Zip Code:57769-0125
Mailing Address - Country:US
Mailing Address - Phone:605-441-2038
Mailing Address - Fax:
Practice Address - Street 1:14116 STURGIS RD
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SD
Practice Address - Zip Code:57769-4010
Practice Address - Country:US
Practice Address - Phone:605-441-2038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2315101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health