Provider Demographics
NPI:1700350071
Name:STARKE, SUZAN JENNIFER
Entity Type:Individual
Prefix:MRS
First Name:SUZAN
Middle Name:JENNIFER
Last Name:STARKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUZAN
Other - Middle Name:JENNIFER
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2077
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-2077
Mailing Address - Country:US
Mailing Address - Phone:707-467-2010
Mailing Address - Fax:
Practice Address - Street 1:410 JONES ST STE C1
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5491
Practice Address - Country:US
Practice Address - Phone:707-463-0405
Practice Address - Fax:707-313-4999
Is Sole Proprietor?:No
Enumeration Date:2019-01-19
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator