Healthcare Provider Details

I. General information

NPI: 1447770060
Provider Name (Legal Business Name): CAITLIN GRACE WILLIAMS PSY.D., LCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2017
Last Update Date: 06/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 W 63RD ST
CHICAGO IL
60621-2032
US

IV. Provider business mailing address

77 W HURON ST APT 1511
CHICAGO IL
60654-5325
US

V. Phone/Fax

Practice location:
  • Phone: 773-388-1600
  • Fax: 773-783-8197
Mailing address:
  • Phone: 608-658-1095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.008859
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: