Healthcare Provider Details

I. General information

NPI: 1598516528
Provider Name (Legal Business Name): KIRSTIE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 10/26/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 CHERRY BLOSSOM CT
PEVELY MO
63070-1347
US

IV. Provider business mailing address

1735 CHERRY BLOSSOM CT
PEVELY MO
63070-1347
US

V. Phone/Fax

Practice location:
  • Phone: 618-954-9167
  • Fax:
Mailing address:
  • Phone: 618-954-9167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2024040150
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: