Provider Demographics
NPI:1861664997
Name:GENTNER, HEATHER A (MA, AUD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:GENTNER
Suffix:
Gender:F
Credentials:MA, AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4275 STEELS POINTE
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-6841
Mailing Address - Country:US
Mailing Address - Phone:330-923-0399
Mailing Address - Fax:330-923-6677
Practice Address - Street 1:4275 STEELS POINTE
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-6841
Practice Address - Country:US
Practice Address - Phone:330-923-0399
Practice Address - Fax:330-923-6677
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA01074231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0101501Medicaid
OHH055960Medicare PIN