Healthcare Provider Details

I. General information

NPI: 1336655893
Provider Name (Legal Business Name): MRS. STAR WARE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. STAR MARSCHKE

II. Dates (important events)

Enumeration Date: 12/20/2017
Last Update Date: 12/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12350 ESSINGTON RD
PLAINFIELD IL
60585-9528
US

IV. Provider business mailing address

12350 ESSINGTON RD
PLAINFIELD IL
60585-9528
US

V. Phone/Fax

Practice location:
  • Phone: 815-439-8024
  • Fax: 815-254-7375
Mailing address:
  • Phone: 815-439-8024
  • Fax: 815-254-7375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.012830
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: