Provider Demographics
NPI:1487988481
Name:WHALEN, HEATHER LOUISE (CCC-SLP, MS)
Entity type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:LOUISE
Last Name:WHALEN
Suffix:
Gender:F
Credentials:CCC-SLP, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 WASHINGTON AVE EXT.
Mailing Address - Street 2:EARLY CHILDHOOD EDUCATION CENT
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205
Mailing Address - Country:US
Mailing Address - Phone:518-456-4466
Mailing Address - Fax:
Practice Address - Street 1:251 WASHINGTON AVE EXT
Practice Address - Street 2:EARLY CHILDHOOD EDUCATION CENTER
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205
Practice Address - Country:US
Practice Address - Phone:518-456-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019137-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist