Provider Demographics
NPI:1710056908
Name:STOCKWELL, GRETCHEN S (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:S
Last Name:STOCKWELL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 HANCOCK RD
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-1109
Mailing Address - Country:US
Mailing Address - Phone:603-924-7503
Mailing Address - Fax:603-547-3232
Practice Address - Street 1:106 HANCOCK RD
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1109
Practice Address - Country:US
Practice Address - Phone:603-924-7503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0236235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30400654Medicaid