Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PS006186L | PA |
N | 103T00000X | Psychologist | PS006186L | PA |
N | 103TR0400X | Rehabilitation Psychologist | PS006186L | PA |
NPI | 1205086188 |
---|---|
Provider Name | Kelli Sue Williams |
First Address | Philadelphia, PA 19146-1414 |
Second Address | Philadelphia, PA 19146-1414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2008 |
Last Update Date | 29/01/2013 |