Healthcare Provider Details

I. General information

NPI: 1326343633
Provider Name (Legal Business Name): BRIDGET M. WILLIAMS LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19925 ENGLISH CT
FARMINGTON MN
55024-8428
US

IV. Provider business mailing address

19925 ENGLISH CT
FARMINGTON MN
55024-8428
US

V. Phone/Fax

Practice location:
  • Phone: 773-558-2146
  • Fax:
Mailing address:
  • Phone: 773-558-2146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP6540
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6022
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number578
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY004475
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number06007
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number3579
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: