Healthcare Provider Details

I. General information

NPI: 1982538476
Provider Name (Legal Business Name): CLARINDA MOFFIST WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7510 170TH AVE NW
RAMSEY MN
55303-5435
US

IV. Provider business mailing address

7510 170TH AVE NW
RAMSEY MN
55303-5435
US

V. Phone/Fax

Practice location:
  • Phone: 318-614-2976
  • Fax:
Mailing address:
  • Phone: 318-614-2976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSP0000001180367
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1005784
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: