Provider Demographics
NPI:1144406307
Name:MIKOL, PAGE NORRIS (MAED, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:PAGE
Middle Name:NORRIS
Last Name:MIKOL
Suffix:
Gender:F
Credentials:MAED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 WATERS EDGE DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-2463
Mailing Address - Country:US
Mailing Address - Phone:919-233-7075
Mailing Address - Fax:919-233-7081
Practice Address - Street 1:3407 W WENDOVER AVE STE H
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1584
Practice Address - Country:US
Practice Address - Phone:336-297-2180
Practice Address - Fax:336-297-2181
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1910235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7458789Medicaid