ETHAN ELLIOT STARK PSYD
NPI 1730607771
Psychologist - Clinical in Chicago, IL

Q: What is Ethan Stark's NPI number?

The NPI number for Ethan Stark is 1730607771. It was assigned to this individual provider in the NPPES registry on August 30, 2017.

Q: What is Ethan Stark's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: When was this NPI record last updated?

The NPPES record for Ethan Stark was last updated on June 8, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since August 30, 2017

3580 W MEDILL AVE APT 2, CHICAGO, IL 60647(608) 335-6705 Get Directions Write a Review

NPPES record last updated: June 8, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 8, 2023, May 25, 2023, Jul 21, 2022 and 1 more (4 updates tracked since 2017).

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About Ethan Elliot Stark Psyd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ETHAN ELLIOT STARK PSYD (NPI 1730607771) is an individual clinical provider in Chicago, Illinois, licensed in Illinois (071.010910) and active in the NPI registry since August 2017.

NPPES Registry Identity

NPI1730607771

Entity TypeIndividualMale

Primary Taxonomy103TC0700X

Provider Legal NameETHAN ELLIOT STARKCredential: PSYD

Location Address3580 W MEDILL AVE APT 2Chicago, IL 60647-2440

Mailing Address70 S River StAurora, IL 60506-5185 · (630) 844-2662

Phone(608) 335-6705

Sole ProprietorYes

Enumeration DateAugust 30, 2017

Last NPPES UpdateJune 8, 20234 updates tracked since enumeration

NPPES CertifiedJune 8, 2023

✔ NPI 1730607771 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in IL · 071.010910

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

3580 W MEDILL AVE APT 2, Chicago, IL 60647

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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ethan Stark's NPI number?

The NPI number for Ethan Stark is 1730607771. It was assigned to this individual provider in the NPPES registry on August 30, 2017.

Where is Ethan Stark located?

Ethan Stark practices at 3580 W Medill Ave Apt 2, Chicago, IL 60647. The listed phone number is (608) 335-6705.

What is Ethan Stark's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

When was this NPI record last updated?

The NPPES record for Ethan Stark was last updated on June 8, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.