Individual
BRENDA WIEGAND WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
3800 S NATIONAL AVE STE 770, SPRINGFIELD, MO 65807-5283
(417) 269-6891
(417) 269-5595
Mailing address
PO BOX 4046, SPRINGFIELD, MO 65808-4046
(417) 269-5712
(417) 269-7567
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
702
KS
103T00000X
Psychologist
Primary
R0440
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
132439
BLUE SHIELD
MO
05
—
499679207
—
MO
Enumeration date
02/26/2007
Last updated
02/07/2019
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