Provider Demographics
NPI:1073610929
Name:MADDEN, TAMARA S (LSCSW)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:S
Last Name:MADDEN
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:S
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSCSW
Mailing Address - Street 1:1531 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-2613
Mailing Address - Country:US
Mailing Address - Phone:620-663-9237
Mailing Address - Fax:
Practice Address - Street 1:1531 WILLOW RD
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-2613
Practice Address - Country:US
Practice Address - Phone:620-200-0234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5686104100000X
KS39291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS012Medicare PIN
KS393302OtherBCBS