Healthcare Provider Details

I. General information

NPI: 1578872834
Provider Name (Legal Business Name): VIVIAN L. TAMKIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 SCIENCE DR STE 300
MADISON WI
53711-1064
US

IV. Provider business mailing address

440 SCIENCE DR STE 300
MADISON WI
53711-1064
US

V. Phone/Fax

Practice location:
  • Phone: 262-999-3495
  • Fax:
Mailing address:
  • Phone: 262-999-3495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number24387
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3709-57
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: