Healthcare Provider Details

I. General information

NPI: 1730445206
Provider Name (Legal Business Name): MS. CAITLYN RAE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3165 MCKELVEY RD SUITE 200
BRIDGETON MO
63044-2550
US

IV. Provider business mailing address

1430 OLIVE STREET SUITE 400
ST. LOUIS MO
63103
US

V. Phone/Fax

Practice location:
  • Phone: 314-206-3902
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: