Provider Demographics
NPI:1033520333
Name:MICHALOWSKI, TARA MARIE (MA)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:MARIE
Last Name:MICHALOWSKI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:MARIE
Other - Last Name:ASHFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:530 TENBY WAY
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-6501
Mailing Address - Country:US
Mailing Address - Phone:760-405-6764
Mailing Address - Fax:
Practice Address - Street 1:530 TENBY WAY
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-6501
Practice Address - Country:US
Practice Address - Phone:760-405-6764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.001272106H00000X
CALMFT100197106H00000X
TX203549106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist