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NPI Code Detail

MEDICARE: KANIESHA WILLIAMS LSW, CADC

MEDICARE:   KANIESHA  WILLIAMS  LSW, CADC
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
1104100000XSocial Worker150107270IL

General Provider Information

NPI Number : 1184303380
Entity Type Code : Individual
Provider Name (Legal Business Name) : KANIESHA WILLIAMS LSW, CADC
Provider Business Mailing Address
First Line : 3700 S WALLACE ST
Second Line :
City : CHICAGO
State : IL
Zip : 60609-1745
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3700 S WALLACE ST
Second Line :
City : CHICAGO
State : IL
Zip : 60609-1745
Country : US
Telephone Number : 773-679-0350
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2023
Last Update Date : 07/14/2023

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Directions to “ KANIESHA WILLIAMS LSW, CADC” Practice Location

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