Provider Demographics
NPI:1811310378
Name:NGUYEN, TOMMY (BS)
Entity type:Individual
Prefix:
First Name:TOMMY
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3055
Mailing Address - Country:US
Mailing Address - Phone:217-373-2430
Mailing Address - Fax:
Practice Address - Street 1:70 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3652
Practice Address - Country:US
Practice Address - Phone:217-398-7785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker