Provider Demographics
NPI:1447494869
Name:WILLIAMS, VALERIE
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 649
Mailing Address - Street 2:2200 FOURTH STREET
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-0649
Mailing Address - Country:US
Mailing Address - Phone:541-523-3646
Mailing Address - Fax:541-523-7602
Practice Address - Street 1:2200 4TH ST
Practice Address - Street 2:2200 FOURTH STREET
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-2615
Practice Address - Country:US
Practice Address - Phone:541-523-3646
Practice Address - Fax:541-523-7602
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR014274Medicaid