MEDICARE: MRS. ANGEL JENELLE WILLIAMS MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149-013510	IL

General Provider Information

NPI Number	:	1366760837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGEL JENELLE WILLIAMS MSW

Provider Business Mailing Address
First Line	:	6250 W NORTH AVE FL 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-3861
Country	:	US
Telephone Number	:	773-622-6218
Fax Number	:	773-622-7440

Provider Business Practice Location Address
First Line	:	6250W NORTH AVE 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-3861
Country	:	US
Telephone Number	:	773-622-6218
Fax Number	:	773-622-7440

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2010
Last Update Date	:	03/17/2018

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