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NPI Code Detail

MEDICARE: MRS. TERESA M STARK MA

MEDICARE: MRS. TERESA M STARK MA
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
1235Z00000XSpeech-Language Pathologist01093584WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881871101
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TERESA M STARK MA
Provider Business Mailing Address
First Line : 2850 5TH AVE
Second Line :
City : HUNTINGTON
State : WV
Zip : 25702-1436
Country : US
Telephone Number : 304-528-5078
Fax Number : 304-528-5344
Provider Business Practice Location Address
First Line : 2850 5TH AVE
Second Line :
City : HUNTINGTON
State : WV
Zip : 25702-1436
Country : US
Telephone Number : 304-528-5078
Fax Number : 304-528-5344
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2008
Last Update Date : 01/29/2008

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Directions to “ MRS. TERESA M STARK MA” Practice Location

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