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NPI Code Detail

MEDICARE: DIEDRE SUZANNE WILLIAMS

MEDICARE: DIEDRE SUZANNE 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1609377852
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIEDRE SUZANNE WILLIAMS
Provider Business Mailing Address
First Line : 5145 EL CAMINO AVE APT 3
Second Line :
City : CARMICHAEL
State : CA
Zip : 95608-5071
Country : US
Telephone Number : 916-613-3977
Fax Number :
Provider Business Practice Location Address
First Line : 1050 FULTON AVE
Second Line :
City : SACRAMENTO
State : CA
Zip : 95825-4272
Country : US
Telephone Number : 916-974-2599
Fax Number : 916-444-8901
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2018
Last Update Date : 02/23/2018

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Directions to “ DIEDRE SUZANNE WILLIAMS ” Practice Location

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