Provider Demographics
NPI:1124315064
Name:WILLIAMSON, ANGIE MARIE (MS, LPCC, RDN, LDN)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:MARIE
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:MS, LPCC, RDN, LDN
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 120
Mailing Address - Street 2:
Mailing Address - City:OSAKIS
Mailing Address - State:MN
Mailing Address - Zip Code:56360-0120
Mailing Address - Country:US
Mailing Address - Phone:320-766-6333
Mailing Address - Fax:
Practice Address - Street 1:610 W 1ST AVE
Practice Address - Street 2:
Practice Address - City:OSAKIS
Practice Address - State:MN
Practice Address - Zip Code:56360-8227
Practice Address - Country:US
Practice Address - Phone:952-484-0841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN886167133V00000X
MNCC02695101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered