Provider Demographics
NPI:1386725083
Name:TOMPKINS, AMY ELIZABETH (MSW, CSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:TOMPKINS
Suffix:
Gender:F
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 COLLEGE AVE NE
Mailing Address - Street 2:APT 4
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3420
Mailing Address - Country:US
Mailing Address - Phone:616-247-3638
Mailing Address - Fax:616-247-0780
Practice Address - Street 1:2135 BUCHANAN AVE SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-2911
Practice Address - Country:US
Practice Address - Phone:616-247-3638
Practice Address - Fax:616-247-0780
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801082833104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801082833OtherLICENSE