Provider Demographics
NPI:1053686352
Name:GRIMES, PAIGE NICOLE (SLP)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:NICOLE
Last Name:GRIMES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7251 US HIGHWAY 83
Mailing Address - Street 2:
Mailing Address - City:WINTERS
Mailing Address - State:TX
Mailing Address - Zip Code:79567-7727
Mailing Address - Country:US
Mailing Address - Phone:325-330-2161
Mailing Address - Fax:
Practice Address - Street 1:800 BROAD AVE
Practice Address - Street 2:
Practice Address - City:BALLINGER
Practice Address - State:TX
Practice Address - Zip Code:76821-2310
Practice Address - Country:US
Practice Address - Phone:325-365-3527
Practice Address - Fax:325-365-2943
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106623235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist