Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | 1-03-1438 | SD |
N | 102L00000X | Psychologist | 419 | SD |
N | 103T00000X | Psychologist | 419 | SD |
Y | 103TB0200X | Cognitive & Behavioral Psychologist | ||
N | 103TM1800X | Intellectual & Developmental Disabilities |
NPI | 1114180064 |
---|---|
Provider Name | Dr. Tracy J Williams |
First Address | Sioux Falls, SD 57104-1322 |
Second Address | Sioux Falls, SD 57104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2008 |
Last Update Date | 22/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6551930 | (05) | SD |