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NPI Code Detail

MEDICARE: ELIJAH STARRK

MEDICARE: ELIJAH STARRK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianWA

General Provider Information

NPI Number : 1659158574
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIJAH STARRK
Provider Business Mailing Address
First Line : 16821 SE MCGILLIVRAY BLVD STE 100
Second Line :
City : VANCOUVER
State : WA
Zip : 98683-0401
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 16821 SE MCGILLIVRAY BLVD STE 100
Second Line :
City : VANCOUVER
State : WA
Zip : 98683-0401
Country : US
Telephone Number : 360-818-9593
Fax Number : 360-828-1001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2023
Last Update Date : 09/13/2023

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Directions to “ ELIJAH STARRK ” Practice Location

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