Individual
ETHAN ELLIOT STARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
3580 W MEDILL AVE APT 2, CHICAGO, IL 60647-2440
(608) 335-6705
Mailing address
70 S RIVER ST, AURORA, IL 60506-5185
(630) 844-2662
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071.010910
IL
Other
Enumeration date
08/30/2017
Last updated
06/08/2023
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