Healthcare Provider Details

I. General information

NPI: 1124315064
Provider Name (Legal Business Name): ANGIE MARIE WILLIAMSON MS, LPCC, RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 W 1ST AVE
OSAKIS MN
56360-8227
US

IV. Provider business mailing address

PO BOX 120
OSAKIS MN
56360-0120
US

V. Phone/Fax

Practice location:
  • Phone: 952-484-0841
  • Fax:
Mailing address:
  • Phone: 320-766-6333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number886167
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC02695
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: