Individual
D'UNDRA WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
1250 MOORE LAKE DR E STE 205D, FRIDLEY, MN 55432-5176
(612) 412-4819
(651) 304-6027
Mailing address
1250 MOORE LAKE DR E STE 205D, FRIDLEY, MN 55432-5176
(612) 412-4819
(651) 304-6027
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
23648
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23648
MN BOARD OF SW
MN
01
—
Q577186700819
DRIVERS LISCENSE
MN
Enumeration date
05/22/2017
Last updated
11/22/2024
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