| Tracy Williams Licsw Llc | |
|
730 E 38th St Ste 107 Minneapolis MN 55407-5218 | |
| (612) 757-0720 | |
| Not Available |
| Full Name | Tracy Williams Licsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 730 E 38th St Ste 107, Minneapolis, Minnesota |
| Authorized Official Name and Position | Tracy R Williams (OWNER) |
| Authorized Official Contact | 6127570720 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tracy Williams Licsw Llc 730 E 38th St Ste 107 Minneapolis MN 55407-5218 Ph: (612) 757-0720 | Tracy Williams Licsw Llc 730 E 38th St Ste 107 Minneapolis MN 55407-5218 Ph: (612) 757-0720 |
| NPI Number | 1770075319 |
|---|---|
| Provider Enumeration Date | 05/30/2018 |
| Last Update Date | 05/30/2018 |
| Medicare PECOS PAC ID | 1759630270 |
|---|---|
| Medicare Enrollment ID | O20180816001977 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770075319 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 13026 (Minnesota) | Primary |
| Provider Name | Tracy R Williams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649216813 PECOS PAC ID: 9739272279 Enrollment ID: I20070829000679 |
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