MEDICARE: ISTARLIIN A AWALE

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
1	101YM0800X	Mental Health Counselor	A400-4018-8568-03	WI

General Provider Information

NPI Number	:	1407702954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISTARLIIN A AWALE

Provider Business Mailing Address
First Line	:	120 E NATIONAL AVE APT 116
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-1879
Country	:	US
Telephone Number	:	614-592-1333
Fax Number	:	614-592-1333

Provider Business Practice Location Address
First Line	:	120 E NATIONAL AVE APT 116
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-1879
Country	:	US
Telephone Number	:	614-592-1333
Fax Number	:	614-592-1333

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2026
Last Update Date	:	03/07/2026

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