Provider Demographics
NPI:1427823723
Name:WILLIAMS, JASMINE M (CHWC, CD(DONA))
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CHWC, CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 JERSEY ST
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-4643
Mailing Address - Country:US
Mailing Address - Phone:618-306-7780
Mailing Address - Fax:
Practice Address - Street 1:1918 JERSEY ST
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4643
Practice Address - Country:US
Practice Address - Phone:618-306-7780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-17
Last Update Date:2023-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL116771172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty