Provider Demographics
NPI:1871291724
Name:TARKINGTON, KEVIN (CERTIFIED GRIEF EDUC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:TARKINGTON
Suffix:
Gender:M
Credentials:CERTIFIED GRIEF EDUC
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:TARKINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CERTIFIED GRIEF EDUC
Mailing Address - Street 1:PO BOX 242352
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-9048
Mailing Address - Country:US
Mailing Address - Phone:414-553-1474
Mailing Address - Fax:
Practice Address - Street 1:6523 N 49TH CT
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-6006
Practice Address - Country:US
Practice Address - Phone:612-715-9696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist