Provider Demographics
NPI:1992958029
Name:WHALEN, CORRINE (MS,CCC,SLP)
Entity type:Individual
Prefix:
First Name:CORRINE
Middle Name:
Last Name:WHALEN
Suffix:
Gender:F
Credentials:MS,CCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12182-3032
Mailing Address - Country:US
Mailing Address - Phone:518-235-5412
Mailing Address - Fax:518-477-7167
Practice Address - Street 1:417 4TH AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12182-3032
Practice Address - Country:US
Practice Address - Phone:518-235-5412
Practice Address - Fax:518-477-7167
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007448-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist