Provider Demographics
NPI:1336655893
Name:WARE, STAR
Entity Type:Individual
Prefix:MRS
First Name:STAR
Middle Name:
Last Name:WARE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:STAR
Other - Middle Name:
Other - Last Name:MARSCHKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12350 ESSINGTON RD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-9528
Mailing Address - Country:US
Mailing Address - Phone:815-439-8024
Mailing Address - Fax:815-254-7375
Practice Address - Street 1:12350 ESSINGTON RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-9528
Practice Address - Country:US
Practice Address - Phone:815-439-8024
Practice Address - Fax:815-254-7375
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.012830235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist