Provider Demographics
NPI:1477268670
Name:TANKSLEY, RICHARD DEAN (MSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DEAN
Last Name:TANKSLEY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2978 WAVERLY WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5075
Mailing Address - Country:US
Mailing Address - Phone:505-435-0519
Mailing Address - Fax:
Practice Address - Street 1:2978 WAVERLY WAY
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5075
Practice Address - Country:US
Practice Address - Phone:505-435-0519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty