Provider Demographics
NPI:1043579584
Name:WHALEN-PEDERSEN, KIRSTEN LANA (MS)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:LANA
Last Name:WHALEN-PEDERSEN
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 1:310 BAKER AVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2140
Mailing Address - Country:US
Mailing Address - Phone:978-287-8245
Mailing Address - Fax:
Practice Address - Street 1:310 BAKER AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2140
Practice Address - Country:US
Practice Address - Phone:978-287-8245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8848235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist