Provider Demographics
NPI:1306077490
Name:PATRICIA K STARK
Entity type:Organization
Organization Name:PATRICIA K STARK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:NBC-HIS
Authorized Official - Phone:563-242-7852
Mailing Address - Street 1:1601 52ND AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6389
Mailing Address - Country:US
Mailing Address - Phone:309-762-6467
Mailing Address - Fax:309-762-7218
Practice Address - Street 1:206 4TH AVE S
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-4311
Practice Address - Country:US
Practice Address - Phone:563-242-7852
Practice Address - Fax:563-242-0452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0033237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty