Healthcare Provider Details

I. General information

NPI: 1538318324
Provider Name (Legal Business Name): EA WILLIAMS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1834 S ASHLAND AVE
CHICAGO IL
60608-3697
US

IV. Provider business mailing address

700 N RANDOLPH ST
GARY IN
46403-2257
US

V. Phone/Fax

Practice location:
  • Phone: 312-624-8396
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227009082
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: