Provider Demographics
NPI:1578611752
Name:TAMMINGA, KAREN K (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:K
Last Name:TAMMINGA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22570 RICKARD RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-9231
Mailing Address - Country:US
Mailing Address - Phone:541-388-8231
Mailing Address - Fax:541-385-7683
Practice Address - Street 1:336 NE NORTON AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4350
Practice Address - Country:US
Practice Address - Phone:541-388-8231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL17601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical