Provider Demographics
NPI:1114455334
Name:PAGE, ANDREA SUZETTE (AUD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:SUZETTE
Last Name:PAGE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:SUZETTE
Other - Last Name:DEAKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6410 OLD MAIN HL
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84322-6410
Mailing Address - Country:US
Mailing Address - Phone:435-797-1374
Mailing Address - Fax:844-308-5865
Practice Address - Street 1:6410 OLD MAIN HL
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84322-8704
Practice Address - Country:US
Practice Address - Phone:435-797-1374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDAUD-3188OtherIDAHO STATE