Healthcare Provider Details

I. General information

NPI: 1366677015
Provider Name (Legal Business Name): WILLIAMS & MORGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 05/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LAWRENCE LANE
MATTESON IL
60443-2933
US

IV. Provider business mailing address

110 LAWRENCE LN
MATTESON IL
60443-2933
US

V. Phone/Fax

Practice location:
  • Phone: 708-351-9742
  • Fax: 708-283-6330
Mailing address:
  • Phone: 708-351-9742
  • Fax: 708-283-6330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MRS. ANTOINETTE C WILLIAMS
Title or Position: PRES./CEO
Credential:
Phone: 708-351-9742