Provider Demographics
NPI:1548503915
Name:WHELAN, CORY JAMES (MS, CCC-SLP/BCBA)
Entity type:Individual
Prefix:MR
First Name:CORY
Middle Name:JAMES
Last Name:WHELAN
Suffix:
Gender:M
Credentials:MS, CCC-SLP/BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 THREE PONDS DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02632-1528
Mailing Address - Country:US
Mailing Address - Phone:508-776-8619
Mailing Address - Fax:
Practice Address - Street 1:79 THREE PONDS DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02632-1528
Practice Address - Country:US
Practice Address - Phone:508-776-8619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-13-13262103K00000X
MASP-8376-SL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst