Provider Demographics
NPI:1235830472
Name:RUEDAS, STARLETTE HEART MAHUSAY (LSW)
Entity type:Individual
Prefix:
First Name:STARLETTE HEART
Middle Name:MAHUSAY
Last Name:RUEDAS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:STARLETTE HEART
Other - Middle Name:
Other - Last Name:RUEDAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:7350 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-1713
Mailing Address - Country:US
Mailing Address - Phone:312-330-7721
Mailing Address - Fax:
Practice Address - Street 1:7350 LAKE ST
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-1713
Practice Address - Country:US
Practice Address - Phone:312-330-7721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.110282104100000X
IL149.0272541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker