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NPI Code Detail

MEDICARE: ELLEN KAUDERS STARR LMSW

MEDICARE: ELLEN KAUDERS STARR LMSW
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
11041C0700XClinical Social Worker6801067242MI

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 : 1144359936
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLEN KAUDERS STARR LMSW
Provider Business Mailing Address
First Line : 114 ORCHARD LAKE RD
Second Line :
City : PONTIAC
State : MI
Zip : 48341-2244
Country : US
Telephone Number : 248-858-7766
Fax Number : 248-858-7201
Provider Business Practice Location Address
First Line : 2045 E WEST MAPLE RD
Second Line : SUITE D-407
City : COMMERCE TOWNSHIP
State : MI
Zip : 48390-3801
Country : US
Telephone Number : 248-624-3811
Fax Number : 248-624-0368
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 07/08/2007

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Directions to “ ELLEN KAUDERS STARR LMSW” Practice Location

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