Provider Demographics
NPI:1649095902
Name:TONKINSON, BROCKTON
Entity type:Individual
Prefix:
First Name:BROCKTON
Middle Name:
Last Name:TONKINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 SKYLINE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-4874
Mailing Address - Country:US
Mailing Address - Phone:618-440-1534
Mailing Address - Fax:
Practice Address - Street 1:812 SKYLINE DR STE 200
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-4874
Practice Address - Country:US
Practice Address - Phone:618-440-1534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical