Provider Demographics
NPI:1568920833
Name:TARCAK, KIMBERLEY JANE (MSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:JANE
Last Name:TARCAK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KIMBERLEY
Other - Middle Name:
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13136 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-2423
Mailing Address - Country:US
Mailing Address - Phone:708-371-5170
Mailing Address - Fax:708-371-0466
Practice Address - Street 1:13136 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2423
Practice Address - Country:US
Practice Address - Phone:708-371-5170
Practice Address - Fax:708-371-0466
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health