Healthcare Provider Details

I. General information

NPI: 1790177657
Provider Name (Legal Business Name): SUSAN WILLIAMS MSW, LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 1ST AVE SE STE 502
CEDAR RAPIDS IA
52402-3222
US

IV. Provider business mailing address

617 BARTLET CT NW
CEDAR RAPIDS IA
52405-2858
US

V. Phone/Fax

Practice location:
  • Phone: 319-721-9088
  • Fax:
Mailing address:
  • Phone: 319-721-9088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number007767
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007767
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: