Provider Demographics
NPI:1699954206
Name:WILLIAMSON, PATTI A (MSW QMHP)
Entity type:Individual
Prefix:MRS
First Name:PATTI
Middle Name:A
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:MSW QMHP
Other - Prefix:
Other - First Name:PATTI
Other - Middle Name:ANN
Other - Last Name:TEELING-SHEPPARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:QMHP
Mailing Address - Street 1:408 E VINE ST
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:IL
Mailing Address - Zip Code:62995-1612
Mailing Address - Country:US
Mailing Address - Phone:618-658-2611
Mailing Address - Fax:615-658-2501
Practice Address - Street 1:408 E VINE ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:IL
Practice Address - Zip Code:62995-1612
Practice Address - Country:US
Practice Address - Phone:618-658-2611
Practice Address - Fax:615-658-2501
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor