Individual
CORBY RAE STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA PC
Contact information
Practice address
100 POLK COUNTY PLZ, SUITE 50, BALSAM LAKE, WI 54810-9071
(715) 485-8842
(715) 485-8490
Mailing address
101 PERRY MOUND RD, BALSAM LAKE, WI 54810-9001
(612) 801-5854
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
119 226
WI
Other
Enumeration date
04/11/2007
Last updated
07/08/2007
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