MEDICARE: GLADYS WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	5597	LA

General Provider Information

NPI Number	:	1104383470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLADYS WILLIAMS

Provider Business Mailing Address
First Line	:	923 EXECUTIVE PARK AVE STE 12
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-2000
Country	:	US
Telephone Number	:	225-303-0212
Fax Number	:	225-303-0216

Provider Business Practice Location Address
First Line	:	923 EXECUTIVE PARK AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-2000
Country	:	US
Telephone Number	:	225-303-0212
Fax Number	:	225-303-0216

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2019
Last Update Date	:	02/22/2019

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Directions to “ GLADYS WILLIAMS ” Practice Location

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