Healthcare Provider Details

I. General information

NPI: 1215778881
Provider Name (Legal Business Name): LAUREN DANIELLE WHITMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WILLOW ST
WEST ROXBURY MA
02132-1537
US

IV. Provider business mailing address

5 WIGET ST APT 6
BOSTON MA
02113-2298
US

V. Phone/Fax

Practice location:
  • Phone: 617-469-3080
  • Fax:
Mailing address:
  • Phone: 267-885-4333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: