Basic Information
| Provider Information | |||||||||
| NPI: | 1316435324 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | NITAUSHA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HETH-CERMAK | ||||||||
| OtherFirstName: | NITAUSHA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | JACKSON RECOVERY CENTERS, INC. | ||||||||
| Address2: | 800 5TH STREET | ||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 51101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122342341 | ||||||||
| FaxNumber: | 7122342395 | ||||||||
| Practice Location | |||||||||
| Address1: | JACKSON RECOVERY CENTERS, INC. | ||||||||
| Address2: | 800 5TH STREET | ||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 51101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122342300 | ||||||||
| FaxNumber: | 7122342392 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2018 | ||||||||
| LastUpdateDate: | 04/25/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 088281 | IA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.