Provider Demographics
NPI:1689800674
Name:PATTERSON-BIDDLE, STARLETTE MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:STARLETTE
Middle Name:MARIE
Last Name:PATTERSON-BIDDLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:STARLETTE
Other - Middle Name:MARIE
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 1115
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53052-1115
Mailing Address - Country:US
Mailing Address - Phone:414-614-7827
Mailing Address - Fax:414-435-0543
Practice Address - Street 1:4025 N 92ND ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1613
Practice Address - Country:US
Practice Address - Phone:414-435-1115
Practice Address - Fax:414-435-0543
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4657-125101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1689800674Medicaid
WI4657-125OtherWISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES