Provider Demographics
NPI:1043670078
Name:TARKOWSKI, SCHANDA
Entity type:Individual
Prefix:
First Name:SCHANDA
Middle Name:
Last Name:TARKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4328 E FREELAND RD
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:MI
Mailing Address - Zip Code:48623-9411
Mailing Address - Country:US
Mailing Address - Phone:989-492-0404
Mailing Address - Fax:989-672-5649
Practice Address - Street 1:4328 E FREELAND RD
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:MI
Practice Address - Zip Code:48623-9411
Practice Address - Country:US
Practice Address - Phone:989-492-0404
Practice Address - Fax:989-672-5649
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015326101YM0800X
MI6401224376101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401224376OtherLPC