Matthew Jacob Stark

NPI #1831896539 in White Bear Lake, Minnesota

Provider Information

NPI Number: 1831896539
Entity Type: Individual
Name: Matthew Jacob Stark
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Enumeration Date: Feb 13, 2023
Last Updated: Feb 13, 2023

Practice Location

Address: 1011 MEADOWLANDS DR STE 1
City: White Bear Lake
State: Minnesota
ZIP Code: 55127-2340
Phone: (612) 445-0300

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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