Provider Demographics
NPI:1144387945
Name:HENNESSEY, ANN-MARIE B (MA, CCC-A)
Entity Type:Individual
Prefix:MS
First Name:ANN-MARIE
Middle Name:B
Last Name:HENNESSEY
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 CHARLES ST
Mailing Address - Street 2:AUDIOLOGY DEPARTMENT
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3002
Mailing Address - Country:US
Mailing Address - Phone:617-573-3266
Mailing Address - Fax:617-573-3023
Practice Address - Street 1:243 CHARLES ST
Practice Address - Street 2:AUDIOLOGY DEPARTMENT
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3002
Practice Address - Country:US
Practice Address - Phone:617-573-3266
Practice Address - Fax:617-573-3023
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA434231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAD0122OtherBLUE CROSS PROVIDER
MAAD0122OtherBLUE CROSS PROVIDER