Healthcare Provider Details

I. General information

NPI: 1497202956
Provider Name (Legal Business Name): MADELINE LYNN TOMPKINS MA A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MADELINE 'MIMI' TOMPKINS

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 MARTIN ST
BLAINE WA
98230-4045
US

IV. Provider business mailing address

9481 DELTOP DR
BLAINE WA
98230-5502
US

V. Phone/Fax

Practice location:
  • Phone: 360-778-4228
  • Fax: 360-778-1423
Mailing address:
  • Phone: 808-781-6464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberNO LICENSE NUMBER YE
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: