Healthcare Provider Details

I. General information

NPI: 1750958856
Provider Name (Legal Business Name): SCHANDA TARKOWSKI PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4328 E FREELAND RD
FREELAND MI
48623-9411
US

IV. Provider business mailing address

4328 E FREELAND RD
FREELAND MI
48623-9411
US

V. Phone/Fax

Practice location:
  • Phone: 989-492-0404
  • Fax:
Mailing address:
  • Phone: 989-492-0404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: SCHANDA JO TARKOWSKI
Title or Position: PRESIDENT
Credential: MA, LLPC
Phone: 989-492-0404