Provider Demographics
NPI:1124639729
Name:TOMPKINS, COURTNEY (APSW)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:TOMPKINS
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11447 2ND ST STE 9B
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-9522
Mailing Address - Country:US
Mailing Address - Phone:815-601-4673
Mailing Address - Fax:
Practice Address - Street 1:2000 E RACINE ST STE 100
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-4300
Practice Address - Country:US
Practice Address - Phone:815-601-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132031-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker