Provider Demographics
NPI:1588649669
Name:GENTILI-STOCKWELL, ANN MARIE C (MA CCC-A)
Entity Type:Individual
Prefix:MS
First Name:ANN MARIE
Middle Name:C
Last Name:GENTILI-STOCKWELL
Suffix:
Gender:F
Credentials:MA CCC-A
Other - Prefix:MS
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:STOCKWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCCA
Mailing Address - Street 1:1244 BOYLSTON ST
Mailing Address - Street 2:STE 303
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2116
Mailing Address - Country:US
Mailing Address - Phone:617-383-6841
Mailing Address - Fax:617-383-6880
Practice Address - Street 1:1244 BOYLSTON ST
Practice Address - Street 2:STE 303
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467
Practice Address - Country:US
Practice Address - Phone:617-383-6830
Practice Address - Fax:617-383-6880
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA460231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAD0104OtherBLUE CROSS BLUE SHIELD
MA03756401Medicare UPIN