Provider Demographics
NPI:1871227413
Name:WHALEN, AMANDA NATALIE (MS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:NATALIE
Last Name:WHALEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 154
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03601-0154
Mailing Address - Country:US
Mailing Address - Phone:508-930-6440
Mailing Address - Fax:
Practice Address - Street 1:300 ROUTE 10 S
Practice Address - Street 2:
Practice Address - City:GRANTHAM
Practice Address - State:NH
Practice Address - Zip Code:03753-3425
Practice Address - Country:US
Practice Address - Phone:603-863-9689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist