Doctor Name: | MR. WILLIAM D SOUTHER |
NPI Number: | 1649315466 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MSW, LICSW |
License Number: | 7484 |
Business Practice Address: | 5833 Pecan St Suite A2 North Branch, MN - 550566689 |
Business Phone Number: | 6512370628 |
Business Fax Number: | 6512370631 |
Mailing Address: | 4989 355th St, NORTH BRANCH |
State: | MN |
Postal Code: | 550565581 |
Phone Number: | 6512370803 |
Fax Number: | |
NPI Enumeration Date: | 02/20/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 7484 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |