Provider Demographics
NPI:1720293988
Name:WILLIAMS, STEPHANIE OLSEN I
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:OLSEN
Last Name:WILLIAMS
Suffix:I
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 1:950 N STATE ST
Mailing Address - Street 2:STE.A
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-1485
Mailing Address - Country:US
Mailing Address - Phone:951-929-9838
Mailing Address - Fax:
Practice Address - Street 1:950 N STATE ST
Practice Address - Street 2:STE.A
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-1485
Practice Address - Country:US
Practice Address - Phone:951-929-9838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator