Healthcare Provider Details

I. General information

NPI: 1225951643
Provider Name (Legal Business Name): ANGELICA ELIZABETH-STAR STCLAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 E STATE ST
CHEBOYGAN MI
49721-2124
US

IV. Provider business mailing address

216 VALE ST 310
CHEBOYGAN MI
49721
US

V. Phone/Fax

Practice location:
  • Phone: 800-645-4737
  • Fax:
Mailing address:
  • Phone: 989-306-8931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: