Provider Demographics
NPI:1144386277
Name:STARUCK, COLLEEN M (MS)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:M
Last Name:STARUCK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-4242
Mailing Address - Country:US
Mailing Address - Phone:773-354-3798
Mailing Address - Fax:630-984-4484
Practice Address - Street 1:549 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-4242
Practice Address - Country:US
Practice Address - Phone:773-354-3798
Practice Address - Fax:630-984-4484
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008486235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist