Provider Demographics
NPI:1679247415
Name:BOLLENBACHER, WHITNEY (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:BOLLENBACHER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 E TULLY ST
Mailing Address - Street 2:
Mailing Address - City:CONVOY
Mailing Address - State:OH
Mailing Address - Zip Code:45832-8864
Mailing Address - Country:US
Mailing Address - Phone:419-749-9100
Mailing Address - Fax:
Practice Address - Street 1:531 E TULLY ST
Practice Address - Street 2:
Practice Address - City:CONVOY
Practice Address - State:OH
Practice Address - Zip Code:45832-8864
Practice Address - Country:US
Practice Address - Phone:419-749-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14091711235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist