Provider Demographics
NPI:1538966023
Name:WILEY, STARRSE VERSHONNA
Entity type:Individual
Prefix:
First Name:STARRSE
Middle Name:VERSHONNA
Last Name:WILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17604 WENTWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-2057
Mailing Address - Country:US
Mailing Address - Phone:574-300-6544
Mailing Address - Fax:
Practice Address - Street 1:224 WESTWOOD LN
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46619-1641
Practice Address - Country:US
Practice Address - Phone:574-300-6544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician