Provider Demographics
NPI:1750436150
Name:STILES, DEREK JASON (PHD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:JASON
Last Name:STILES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 LONGWOOD AVE
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-355-6461
Mailing Address - Fax:312-942-7068
Practice Address - Street 1:333 LONGWOOD AVE
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-355-6461
Practice Address - Fax:312-942-7068
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2119231H00000X
IL147.001329231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist