Provider Demographics
NPI:1356559454
Name:WHITNEY, MICHAEL B (MS-CCC-SLP-CEIS)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:B
Last Name:WHITNEY
Suffix:
Gender:M
Credentials:MS-CCC-SLP-CEIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 IRVING ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2467
Mailing Address - Country:US
Mailing Address - Phone:508-799-3028
Mailing Address - Fax:
Practice Address - Street 1:20 IRVING ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2467
Practice Address - Country:US
Practice Address - Phone:508-799-3028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5227235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist