Provider Demographics
NPI:1386709483
Name:TARKOWSKI, JANET TRUDEE (EDD)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:TRUDEE
Last Name:TARKOWSKI
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 W MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-3706
Mailing Address - Country:US
Mailing Address - Phone:269-384-6055
Mailing Address - Fax:269-384-6056
Practice Address - Street 1:4021 W MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-3706
Practice Address - Country:US
Practice Address - Phone:269-384-6055
Practice Address - Fax:269-384-6056
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006869103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301006869OtherPSYCHOLOGY LICENSE NUMBER
11290266OtherCAQH
MI68-0-C9-4592-0OtherBCBS
MI68-0-C9-4592-0OtherBCBS
MI68-0-C9-4592-0OtherBCBS
MIOP16540Medicare UPIN