Provider Demographics
NPI:1588059695
Name:STARK, KATHERINE ELIZABETH
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:STARK
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 1:930 W CENTERVILLE RD # 930C
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-5823
Mailing Address - Country:US
Mailing Address - Phone:972-303-7021
Mailing Address - Fax:
Practice Address - Street 1:305 NE LOOP 820
Practice Address - Street 2:BUISNESS TOWER 1, SUITE 200
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-7209
Practice Address - Country:US
Practice Address - Phone:817-292-8787
Practice Address - Fax:817-789-6849
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX389062355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant