Individual
ANGELA D STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
808 MILL LAKE RD, FORT WAYNE, IN 46845-6400
(260) 338-1241
(260) 338-1231
Mailing address
124 KLINGER ST, PLYMOUTH, IN 46563-1235
(260) 338-1241
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22004128A
IN
Other
Enumeration date
05/02/2007
Last updated
07/09/2007
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