MEDICARE: DEBBIE J 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	34003471A	IN
2	1041C0700X	Clinical Social Worker	0779	KY

General Provider Information

NPI Number	:	1477672277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBBIE J WILLIAMS

Provider Business Mailing Address
First Line	:	8303 TERRY RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40258-1747
Country	:	US
Telephone Number	:	502-216-8724
Fax Number	:	502-933-5402

Provider Business Practice Location Address
First Line	:	107 W MAPLE ST # 201
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-3441
Country	:	US
Telephone Number	:	502-216-8724
Fax Number	:

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/08/2007

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