Provider Demographics
NPI:1851628952
Name:TSIAKALIS, TINA (LM, CPM)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:
Last Name:TSIAKALIS
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6219 22ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6917
Mailing Address - Country:US
Mailing Address - Phone:206-526-8312
Mailing Address - Fax:
Practice Address - Street 1:1500 EASTLAKE AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3707
Practice Address - Country:US
Practice Address - Phone:206-407-3397
Practice Address - Fax:206-407-3775
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW 60095894176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1770880429Medicaid