Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 01435 | MO |
Y | 103TC0700X | Clinical Psychologist | 01435 | MO |
NPI | 1013011634 |
---|---|
Provider Name | Dr. Daniel Jeremy Williger |
First Address | Saint Louis, MO 63127-1030 |
Second Address | Saint Louis, MO 63127-1030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2006 |
Last Update Date | 30/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
493524300 | (05) | MO |
MA2526 | MEDICARE PTAN (01) | MO |