Provider Demographics
NPI:1598339129
Name:BACIGALUPO, TAMMY JEAN (SUDPT)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:JEAN
Last Name:BACIGALUPO
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 E BLEVINS RD S
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-9106
Mailing Address - Country:US
Mailing Address - Phone:360-281-8868
Mailing Address - Fax:
Practice Address - Street 1:200 LILLY RD NE STE C
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5080
Practice Address - Country:US
Practice Address - Phone:360-918-8336
Practice Address - Fax:360-972-2152
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)