Healthcare Provider Details

I. General information

NPI: 1114180064
Provider Name (Legal Business Name): TRACY J WILLIAMS PH,D., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 W RUSSELL STREET
SIOUX FALLS SD
57104
US

IV. Provider business mailing address

1105 W RUSSELL ST
SIOUX FALLS SD
57104-1322
US

V. Phone/Fax

Practice location:
  • Phone: 605-271-2690
  • Fax: 605-271-3956
Mailing address:
  • Phone: 605-271-2690
  • Fax: 605-271-3956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number419
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-03-1438
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: