Healthcare Provider Details

I. General information

NPI: 1639980832
Provider Name (Legal Business Name): MARK TOMPKINS SOCIAL WORKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 01/11/2026
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 W WASHINGTON AVE
JACKSON MI
49203-1236
US

IV. Provider business mailing address

2424 W WASHINGTON AVE
JACKSON MI
49203-1236
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-6788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851118841
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: