Provider Demographics
NPI:1609031988
Name:TARKOWSKI, SARAH BETH (LMSW)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:BETH
Last Name:TARKOWSKI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:BETH
Other - Last Name:BLASIUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-0010
Mailing Address - Country:US
Mailing Address - Phone:517-676-9788
Mailing Address - Fax:
Practice Address - Street 1:318 E MAIN ST STE Z
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331-1714
Practice Address - Country:US
Practice Address - Phone:616-894-6673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010902501041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical