Provider Demographics
NPI:1245603380
Name:WHIPPLE, ERIKA (LATC)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:WHIPPLE
Suffix:
Gender:F
Credentials:LATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-1699
Mailing Address - Country:US
Mailing Address - Phone:413-596-9125
Mailing Address - Fax:
Practice Address - Street 1:423 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095-1699
Practice Address - Country:US
Practice Address - Phone:413-596-9125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4607Medicaid