Provider Demographics
NPI:1699807735
Name:STILLITANO, GINA (AUD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:STILLITANO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 W MARKET ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3335
Mailing Address - Country:US
Mailing Address - Phone:330-869-9911
Mailing Address - Fax:
Practice Address - Street 1:3200 W MARKET ST
Practice Address - Street 2:SUITE 108
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3335
Practice Address - Country:US
Practice Address - Phone:330-869-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147.001212231H00000X
OHA.01565231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK51146Medicare PIN