Provider Demographics
NPI:1396170643
Name:WHALEN, ANGELICA M (SLP)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:M
Last Name:WHALEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 E AYERS ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5685
Mailing Address - Country:US
Mailing Address - Phone:850-240-6910
Mailing Address - Fax:
Practice Address - Street 1:1405 E AYERS ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5685
Practice Address - Country:US
Practice Address - Phone:850-240-6910
Practice Address - Fax:850-240-6910
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4317235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist