Provider Demographics
NPI:1033765201
Name:PAIGE, MIRIAM (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:PAIGE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 S NIAGARA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1352
Mailing Address - Country:US
Mailing Address - Phone:443-415-1592
Mailing Address - Fax:
Practice Address - Street 1:383 S NIAGARA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1352
Practice Address - Country:US
Practice Address - Phone:443-415-1592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0003385235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist