Healthcare Provider Details

I. General information

NPI: 1255576856
Provider Name (Legal Business Name): BARBARA JEAN WILLIAMSON LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 11/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4123 E LAKE ST
MINNEAPOLIS MN
55406-2255
US

IV. Provider business mailing address

451 LEXINGTON PKWY N
SAINT PAUL MN
55104-4636
US

V. Phone/Fax

Practice location:
  • Phone: 612-728-2061
  • Fax:
Mailing address:
  • Phone: 651-280-2310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14152
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: