Provider Demographics
NPI:1023639283
Name:WILLIAMS, PRISCILLA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7515 FALCON CREST DR # 200
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-5014
Mailing Address - Country:US
Mailing Address - Phone:541-904-5216
Mailing Address - Fax:541-527-4347
Practice Address - Street 1:7515 FALCON CREST DR # 200
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-5014
Practice Address - Country:US
Practice Address - Phone:541-904-5216
Practice Address - Fax:541-527-4347
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL14257104100000X, 1041S0200X, 1041C0700X
MO2023013955104100000X, 1041C0700X, 1041S0200X
MO2020005861104100000X, 1041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO830083102Medicaid