Provider Demographics
NPI:1114742392
Name:TAMBLYN, FRANKIE SUZANNE (QMHA-R)
Entity type:Individual
Prefix:
First Name:FRANKIE
Middle Name:SUZANNE
Last Name:TAMBLYN
Suffix:
Gender:X
Credentials:QMHA-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3480 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-6368
Mailing Address - Country:US
Mailing Address - Phone:541-690-9215
Mailing Address - Fax:
Practice Address - Street 1:1144 GATEWAY LOOP STE 200
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-7706
Practice Address - Country:US
Practice Address - Phone:541-686-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker