Provider Demographics
NPI:1134214612
Name:STERN, ILENE L (AUDIOLOGIST, MS)
Entity type:Individual
Prefix:
First Name:ILENE
Middle Name:L
Last Name:STERN
Suffix:
Gender:F
Credentials:AUDIOLOGIST, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:CANTERBURY
Mailing Address - State:NH
Mailing Address - Zip Code:03224
Mailing Address - Country:US
Mailing Address - Phone:603-783-4866
Mailing Address - Fax:603-634-5052
Practice Address - Street 1:28 WEBSTER STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104
Practice Address - Country:US
Practice Address - Phone:603-634-4327
Practice Address - Fax:603-634-5052
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHA115231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH7306454Y0NH 02OtherANTHEM
NHAA35731OtherHARVARD PILGRIM
NH30432308Medicaid
NH676960OtherCIGNA
NH676960OtherCIGNA