Provider Demographics
NPI:1275005175
Name:GARDNER, PAIGE LEE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:PAIGE
Middle Name:LEE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7008 SLATE CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-7415
Mailing Address - Country:US
Mailing Address - Phone:301-675-1478
Mailing Address - Fax:
Practice Address - Street 1:101 CLARKE PL
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6529
Practice Address - Country:US
Practice Address - Phone:301-360-2045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02563235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist